高纤维蛋白和血小板血栓预测癌症患者血栓切除术后中风复发或死亡风险
High fibrin and platelet clot predicts stroke recurrence or mortality after thrombectomy in patients with active cancer
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影响因子:4.3
分区:医学2区 Top / 神经成像1区 外科1区
发表日期:2025 Jan 26
作者:
Chuan-Hsiu Fu, Chih-Hao Chen, Yen-Heng Lin, Chung-Wei Lee, Li-Kai Tsai, Sung-Chun Tang, Chia-Tung Shun, Jiann-Shing Jeng
DOI:
10.1136/jnis-2024-022033
摘要
纤维蛋白（Fibrin）和血小板（Platelet, FP）丰富的血栓已被证实与癌症相关中风有关。本研究旨在探讨血栓组成成分在癌症患者经历中风后接受血管内血栓切除术（EVT）后临床结局中的预后作用。我们纳入2015年3月至2021年11月期间接受EVT的急性缺血性中风患者。这些患者被分为三组：活动期癌症患者、非活动期癌症患者和无癌症患者。利用苏木精-伊红染色技术定量血栓中纤维蛋白和血小板的百分比。主要结局定义为在中风事件后90天内任何中风复发或死亡。共纳入420名血栓取出患者，其中50名为活动期癌症，23名非活动期癌症，347名无癌症。结果显示，来自活动期癌症患者的血栓中纤维蛋白和血小板比例显著高于其他两组。活动期癌症组的主要结局发生率也更高。调整临床变量后，高比例的血栓纤维蛋白和血小板仍与该组的主要结局显著相关（调整比值比[aOR]，1.03；95%置信区间[CI]，1.00-1.06；P=0.028），而在其他两组中则无显著关联。在接受EVT的中风患者中，血栓中高比例的纤维蛋白不仅能识别活动期癌症患者，还能预测90天内的中风复发或死亡风险。
Abstract
Fibrin and platelet (FP)-rich clots have been shown to be associated with cancer-related stroke. This study aims to investigate the prognostic role of thrombus composition in clinical outcomes among cancer patients who experienced stroke and received endovascular thrombectomy (EVT).We included acute ischemic stroke patients who underwent EVT between March 2015 and November 2021. These patients were categorized into three groups: those with active cancer, those with non-active cancer, and those without cancer. The percentages of FP in clots were quantified under hematoxylin and eosin staining. The primary outcome was defined as any stroke recurrence or mortality within 90 days following the index stroke event.A total of 420 patients with retrieved clots were included in the study. This cohort comprised 50 patients with active cancer, 23 patients with non-active cancer, and 347 patients without cancer. The percentage of FP was significantly higher in thrombi retrieved from patients with active cancer compared with the other two groups. Patients in the active cancer group exhibited a higher rate of the primary outcome compared with the other groups. After adjusting for clinical variables, a higher percentage of FP in thrombi remained significantly associated with the primary outcome in the active cancer group (adjusted odds ratio (aOR) =1.03 (1.00-1.06), P=0.028), but not in the other two groups.Among stroke patients receiving EVT, thrombi with a higher percentage of FP not only identify individuals with active cancer but also predict stroke recurrence or mortality within 90 days.