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Open Access Research article

Risk of ischemic stroke in patients with ovarian cancer: a nationwide population-based study

Ai-Seon Kuan12, Chung-Jen Teng234, Hua-Hsi Wu56, Vincent Yi-Fong Su27, Yung-Tai Chen8, Sheng-Hsuan Chien9, Chiu-Mei Yeh10, Li-Yu Hu11, Tzeng-Ji Chen103, Cheng-Hwai Tzeng9 and Chia-Jen Liu239*

Author Affiliations

1 Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

2 School of Medicine, National Yang-Ming University, Taipei, Taiwan

3 Institute of Public Health, National Yang-Ming University, Taipei, Taiwan

4 Division of Oncology and Hematology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan

5 Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

6 Department of Obstetrics & Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan

7 Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

8 Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan

9 Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

10 Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

11 Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

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BMC Medicine 2014, 12:53  doi:10.1186/1741-7015-12-53

Published: 25 March 2014

Abstract

Background

Cancer patients are at risk of thromboembolism. However, studies investigating the relationship between ovarian cancer and ischemic stroke are lacking. The objectives of this study were to assess the association between ovarian cancer and ischemic stroke, and to determine the predictive risk factors.

Methods

Ovarian cancer patients aged 20 years and older without antecedent cerebrovascular events and who were followed up for more than 1 year between 1 January 2003 and 31 December 2011 were recruited from the Taiwan National Health Insurance database. Hazard ratios (HRs) of stroke risk for ovarian cancer patients compared with an age- and comorbidity-matched cohort were calculated by Cox proportional regression analysis. The difference in cumulative ischemic stroke incidence between ovarian cancer patients and the matched cohort was analyzed with the Kaplan-Meier method and tested with the log-rank test.

Results

Each cohort (ovarian cancer and matched cohort) consisted of 8,810 individuals, with a median age of 49 years. After a median follow-up of 2.68 and 3.85 years, respectively, the ischemic stroke incidence was 1.38-fold higher in the ovarian cancer cohort than in the comparison cohort (9.4 versus 6.8 per 1,000 person-years), with an age- and comorbidity-adjusted HR of 1.49 (P <0.001). The ischemic stroke risk imposed by ovarian cancer was more prominent in patients under 50 years old (HR 2.28; P <0.001) compared with patients 50 years and older (HR 1.33; P = 0.005). Significant risk factors predicting stroke development were age 50 years and older (HR 2.21; P <0.001), hypertension (HR 1.84; P <0.001), diabetes mellitus (HR 1.71; P <0.001), and treatment with chemotherapy (HR 1.45; P = 0.017), especially platinum-based regimens.

Conclusions

Ovarian cancer patients were at an increased risk of developing ischemic stroke. Age, hypertension, diabetes, and chemotherapy treatment were independent risk factors.

Keywords:
Chemotherapy; Ischemic stroke; Ovarian cancer; Platinum; Population-based study