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Abstract
Objective Accumulating evidence suggests that cancer survivors may have a relatively higher risk of stroke. The aim of this meta-analysis was to determine whether cancer survivors have a relatively higher risk of stroke than cancer-free populations on the basis of published data from population-based cohort studies.
Methods PubMed, Embase, and Cochrane Library were searched from inception to February 8, 2020, for population-based cohort studies. Effect estimates with 95% confidence intervals (CIs) were pooled using the random-effects model. We conducted subgroup analyses and meta-regression to explore sources of heterogeneity and the stability of the results.
Results Twenty population-based cohort studies involving 10,479,530 participants were identified. Overall, the relative risk (RR) for stroke in cancer survivors was 1.66 (95% CI 1.35–2.04; p < 0.001) compared with that in cancer-free controls; survivors of head and neck, hematologic, lung, pancreas, and stomach cancer (all p < 0.05) showed consistently significant results, whereas no significant increased risk was observed for patients with other cancer types. The effects were more prominent in cancer survivors with female sex (RR 1.38, 95% CI 1.18–1.61; p < 0.001), younger age at cancer diagnosis (<45 years) (RR 2.57, 95% CI 1.27–5.19; p = 0.009), and shorter cancer survival duration (≥1–2 years) (RR 1.69, 95% CI 1.18–2.42; p = 0.004). Moreover, cancer survivors had a significantly increased risk of ischemic stroke (RR 1.53, 95% CI 1.28–1.84; p < 0.001) compared with hemorrhagic stroke.
Conclusions Cancer plays a critical role in the etiologic of stroke. Due to the existence of substantial heterogeneity among the included studies, the results should be interpreted with caution. However, early prevention and effective intervention of stroke in cancer survivors require attention from health policy makers.
Glossary
- CI=
- confidence interval;
- HR=
- hazard ratio;
- ICD=
- International Classification of Diseases;
- MOOSE=
- Meta-Analysis of Observational Studies in Epidemiology;
- NOS=
- Newcastle-Ottawa scale;
- PRISMA=
- Preferred Reporting Items for Systematic Reviews and Meta-Analyses;
- RR=
- relative risk;
- SIR=
- standardized incidence ratio
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 143
- Received March 25, 2020.
- Accepted in final form August 25, 2020.
- © 2020 American Academy of Neurology
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