Cancer and Tumor-Associated Childhood Stroke: Results From the International Pediatric Stroke Study.,Pediatric Neurology

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Cancer and Tumor-Associated Childhood Stroke: Results From the International Pediatric Stroke Study.
Pediatric Neurology ( IF 3.8 ) Pub Date : 2020-06-10 , DOI: 10.1016/j.pediatrneurol.2020.06.002
Lisa R Sun ₁ , Alexandra Linds ₂ , Mukta Sharma ₃ , Mubeen Rafay ₄ , Sudhakar Vadivelu ₅ , Sarah Lee ₆ , Leonardo R Brandão ₇ , Brian Appavu ₈ , Jeremie H Estepp ₉ , Juliette Hukin ₁₀ , Sahar M A Hassanein ₁₁ , Anthony Chan ₁₂ , Lauren A Beslow ₁₃ ,

Affiliation

Division of Pediatric Neurology, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland; Division of Cerebrovascular Neurology, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland.
Division of Neurology, Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada.
Division of Hematology Oncology, Children's Mercy, University of Missouri Kansas City, Kansas City, Missouri.
Section of Pediatric Neurology, Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
Division of Neurosurgery, Department of Neurosurgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurosurgery, Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Division of Child Neurology, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, California.
Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Department of Child Health and Neurology, University of Arizona College of Medicine - Phoenix Barrow Neurologic Institute at Phoenix Children's Hospital, Phoenix, Arizona.
Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Division of Neurology, Department of Pediatrics, Children's and Women's Health Centre, Vancouver, British Columbia, Canada; Division of Oncology, Department of Pediatrics, Children's and Women's Health Centre, Vancouver, British Columbia, Canada.
Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Paediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Background

The prevalence of cancer among children with stroke is unknown. This study sought to evaluate cancer- and tumor-associated childhood ischemic stroke in a multinational pediatric stroke registry.

Methods

Children aged 29 days to less than 19 years with arterial ischemic stroke or cerebral sinovenous thrombosis enrolled in the International Pediatric Stroke Study between January 2003 and June 2019 were included. Data including stroke treatment and recurrence were compared between subjects with and without cancer using Wilcoxon rank sum and chi-square tests.

Results

Cancer or tumor was present in 99 of 2968 children (3.3%) with arterial ischemic stroke and 64 of 596 children (10.7%) with cerebral sinovenous thrombosis. Among children in whom cancer type was identified, 42 of 88 arterial ischemic stroke cases (48%) had brain tumors and 35 (40%) had hematologic malignancies; 45 of 58 cerebral sinovenous thrombosis cases (78%) had hematologic malignancies and eight (14%) had brain tumors. Of 54 cancer-associated arterial ischemic stroke cases with a known cause, 34 (63%) were due to arteriopathy and nine (17%) were due to cardioembolism. Of 46 cancer-associated cerebral sinovenous thrombosis cases with a known cause, 41 (89%) were related to chemotherapy-induced or other prothrombotic states. Children with cancer were less likely than children without cancer to receive antithrombotic therapy for arterial ischemic stroke (58% vs 80%, P = 0.007) and anticoagulation for cerebral sinovenous thrombosis (71% vs 87%, P = 0.046). Recurrent arterial ischemic stroke (5% vs 2%, P = 0.04) and cerebral sinovenous thrombosis (5% vs 1%, P = 0.006) were more common among children with cancer.

Conclusions

Cancer is an important risk factor for incident and recurrent childhood stroke. Stroke prevention strategies for children with cancer are needed.

中文翻译：

癌症和与肿瘤相关的儿童中风：国际儿童中风研究的结果。

背景

中风患儿中癌症的患病率尚不清楚。这项研究旨在评估跨国儿童儿科卒中登记册中与癌症和肿瘤相关的儿童缺血性中风。

方法

纳入了2003年1月至2019年6月间参加国际小儿卒中研究的29天至19岁以下患有动脉缺血性卒中或脑窦静脉血栓形成的儿童。使用Wilcoxon秩和和卡方检验比较了患有和不患有癌症的受试者之间的卒中治疗和复发数据。

结果

在2968例患有动脉缺血性卒中的儿童中，有99例（3.3％）存在癌症或肿瘤，而在596例脑窦静脉血栓形成的儿童中，则存在64个癌症（10.7％）。在确定为癌症类型的儿童中，88例动脉缺血性中风病例中有42例（48％）患有脑肿瘤，35例（40％）患有血液系统恶性肿瘤。58例脑窦静脉血栓形成病例中有45例（78％）患有血液系统恶性肿瘤，8例（14％）患有脑肿瘤。在54例与癌症相关的已知原因的动脉缺血性中风病例中，有34例（63％）是由于动脉病变引起的，而9例（17％）是由于心脏栓塞引起的。在已知原因的46例癌症相关的脑窦静脉血栓形成病例中，有41例（89％）与化学疗法诱发或其他血栓形成前状态有关。P = 0.007）和抗凝治疗脑窦静脉血栓形成（71％比87％，P = 0.046）。复发性动脉缺血性卒中（5％vs 2％，P = 0.04）和脑窦静脉血栓形成（5％vs 1％，P = 0.006）在癌症儿童中更为常见。