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January 11, 2022; 98 (2) Research Article

Risk of Stroke in Nasopharyngeal Cancer Survivors

A National Registry-Based Population Cohort Study

Teng Hwee Tan, Huili Zheng, Timothy Cheo, View ORCID ProfileJeremy Tey, Yu Yang Soon
First published November 12, 2021, DOI: https://doi.org/10.1212/WNL.0000000000013058
Teng Hwee Tan
From the Department of Radiation Oncology (T.H.T., T.C., J.T., Y.Y.S.), National University Cancer Institute; National University (T.H.T., T.C., J.T., Y.Y.S.); National University Health System (T.H.T., T.C., J.T., Y.Y.S.); and Health Promotion Board (H.Z.), National Registry of Diseases Office, Singapore.
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Huili Zheng
From the Department of Radiation Oncology (T.H.T., T.C., J.T., Y.Y.S.), National University Cancer Institute; National University (T.H.T., T.C., J.T., Y.Y.S.); National University Health System (T.H.T., T.C., J.T., Y.Y.S.); and Health Promotion Board (H.Z.), National Registry of Diseases Office, Singapore.
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Timothy Cheo
From the Department of Radiation Oncology (T.H.T., T.C., J.T., Y.Y.S.), National University Cancer Institute; National University (T.H.T., T.C., J.T., Y.Y.S.); National University Health System (T.H.T., T.C., J.T., Y.Y.S.); and Health Promotion Board (H.Z.), National Registry of Diseases Office, Singapore.
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Jeremy Tey
From the Department of Radiation Oncology (T.H.T., T.C., J.T., Y.Y.S.), National University Cancer Institute; National University (T.H.T., T.C., J.T., Y.Y.S.); National University Health System (T.H.T., T.C., J.T., Y.Y.S.); and Health Promotion Board (H.Z.), National Registry of Diseases Office, Singapore.
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  • ORCID record for Jeremy Tey
Yu Yang Soon
From the Department of Radiation Oncology (T.H.T., T.C., J.T., Y.Y.S.), National University Cancer Institute; National University (T.H.T., T.C., J.T., Y.Y.S.); National University Health System (T.H.T., T.C., J.T., Y.Y.S.); and Health Promotion Board (H.Z.), National Registry of Diseases Office, Singapore.
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Risk of Stroke in Nasopharyngeal Cancer Survivors
A National Registry-Based Population Cohort Study
Teng Hwee Tan, Huili Zheng, Timothy Cheo, Jeremy Tey, Yu Yang Soon
Neurology Jan 2022, 98 (2) e115-e124; DOI: 10.1212/WNL.0000000000013058

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Abstract

Background and Objectives We aim to determine the risk of stroke and death within 30 days after stroke in nasopharyngeal cancer (NPC) survivors.

Methods We conducted a population-based cohort study of patients diagnosed with NPC from January 1, 2005, to December 31, 2017. Using the cancer and stroke disease registries and the Singapore general population as the reference population, we report the age-standardized incidence rate differences (SIRDs) ratios (SIRs) and the cumulative incidence of stroke and the standardized mortality rate differences (SMRDs) and ratios (SMRs) for all causes of death within 30 days after stroke for NPC survivors.

Results At a median follow-up of 48.4 months (interquartile range 19.8–92.9 months) for 3,849 patients diagnosed with NPC, 96 patients developed stroke. The overall SIRD and SIR for stroke were 3.12 (95% confidence interval [CI] 2.09–4.15) and 2.54 (95% CI 2.08–3.10), respectively. The SIRD was highest for the age group 70 to 79 years old (8.84 cases per 1,000 person-years, 95% CI 0.46–17.21), while the SIR was highest for the age group 30 to 39 years old (16.41, 95% CI 6.01–35.82). The SIRD and SIR for stage 1 disease were (6.96 cases per 1000 person-years, 95% CI 2.16–11.77) and (4.15, 95% CI 2.46–7.00), respectively. The SMRD and SMR for all cause deaths within 30 days of stroke were (3.20 cases per 100 persons, 95% CI −3.87 to 10.28) and (1.34, 95% CI 0.76–2.37), respectively.

Discussion The overall risk of stroke was markedly elevated in survivors of NPC, especially in stage 1 disease, compared to the general population. The risk of death within 30 days of stroke was not significantly higher for NPC survivors.

Classification of Evidence This study provides Class II evidence of the increased risk of stroke in survivors of NPC compared to the general population.

Glossary

CI=
confidence interval;
CuI=
cumulative incidence;
ICD-9-CM=
International Classification of Diseases, 9th Revision, Clinical Modification;
ICD-10-AM=
International Classification of Diseases, 10th Revision, Australian Modification;
IQR=
interquartile range;
NPC=
nasopharyngeal cancer;
SCR=
Singapore Cancer Registry;
SIR=
standardized incidence rate ratio;
SIRD=
standardized incidence rate difference;
SMR=
standardized mortality rate ratio;
SMRD=
standardized mortality rate difference;
SSR=
Singapore Stroke Registry

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.

  • Class of Evidence: NPub.org/coe

  • Received March 30, 2021.
  • Accepted in final form November 2, 2021.
  • © 2021 American Academy of Neurology
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