Published online Nov 21, 2018. doi: 10.3748/wjg.v24.i43.4950
Peer-review started: September 4, 2018
First decision: October 24, 2018
Revised: November 2, 2018
Accepted: November 8, 2018
Article in press: November 8, 2018
Published online: November 21, 2018
Processing time: 78 Days and 0.2 Hours
To investigate the specific biomarkers and potential pathogenesis of colorectal cancer-related ischemic stroke (CRCIS).
A retrospective study was conducted on CRCIS patients (colorectal cancer patients with ischemic stroke without conventional stroke risk factors) registered at seven centers between January 2007 and December 2017. Clinical data and laboratory and imaging findings were compared with age- and sex- matched patients with colorectal cancer (CRC) without ischemic stroke that were admitted to the same hospital during the same period. Univariate and multivariate analyses were performed to analyze the independent risk factors for CRCIS. A receiver operator characteristic curve was configured to calculate the optimal cut-off value of the products of the independent risk factors for CRCIS.
A total of 114 CRCIS patients and 114 CRC patients were included. Multiple lesions in multiple vascular territories were common in CRCIS patients (71, 62.28%). The levels of plasma D-dimer, carcinoembryonic antigen (CEA), cancer antigen 125, and neutrophil count were significantly higher in CRCIS patients than in CRC patients. Multiple logistic regression analysis revealed that plasma D-dimer levels [odds ratio (OR) = 1.002, 95% confidence interval (CI): 1.001-1.003, P < 0.001], CEA levels (OR = 1.011, 95%CI: 1.006-1.015, P < 0.001), and neutrophil count levels (OR = 1.626, 95%CI: 1.268-2.087, P < 0.001) were independent risk factors for CRCIS. In addition, receiver operator characteristic curve revealed that the area under curve for the products of plasma D-dimer, CEA, and neutrophil count was 0.889 ± 0.022 (95%CI: 0.847-0.932, P < 0.001), and the optimal cut-off value for the product was 252.06, which was called the CRCIS Index, with a sensitivity of 86.0% and specificity of 79.8%.
Hypercoagulability induced by elevated CEA and neutrophils may be an important cause of CRCIS. The CRCIS index, which serves as a biomarker of CRCIS, needs further study.
Core tip: Although cancer-related stroke has long been known, its biomarkers and underling pathogenesis are still unclear. It was hypothesized that a specific cancer type may affect the development of ischemic stroke (IS) according to its primary site, pathological type, and growth stage. It is reported that colorectal cancer can increase the risk of IS. We conducted a retrospective study on colorectal cancer-related IS (CRCIS) patients. We suggest that hypercoagulability induced by elevated carcinoembryonic antigen and increased neutrophil count are the main pathogenic factors in CRCIS, and the CRCIS Index, which serves as a biomarker of CRCIS, needs further study.