Cargando…

Cerebral ischemic events in patients with pancreatic cancer: A retrospective cohort study of 17 patients and a literature review

Stroke is a dramatic complication of pancreatic cancer with mechanisms related to oncological disease. A better description of the characteristics of cerebrovascular events would help better understand the pathogeny and protect vulnerable patients. We thus conducted a descriptive analysis of clinica...

Descripción completa

Detalles Bibliográficos
Autores principales: Bonnerot, Mathieu, Humbertjean, Lisa, Mione, Gioia, Lacour, Jean-Christophe, Derelle, Anne-Laure, Sanchez, Jean-Charles, Riou-Comte, Nolwenn, Richard, Sébastien
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4937929/
https://www.ncbi.nlm.nih.gov/pubmed/27368015
http://dx.doi.org/10.1097/MD.0000000000004009
_version_ 1782441794540142592
author Bonnerot, Mathieu
Humbertjean, Lisa
Mione, Gioia
Lacour, Jean-Christophe
Derelle, Anne-Laure
Sanchez, Jean-Charles
Riou-Comte, Nolwenn
Richard, Sébastien
author_facet Bonnerot, Mathieu
Humbertjean, Lisa
Mione, Gioia
Lacour, Jean-Christophe
Derelle, Anne-Laure
Sanchez, Jean-Charles
Riou-Comte, Nolwenn
Richard, Sébastien
author_sort Bonnerot, Mathieu
collection PubMed
description Stroke is a dramatic complication of pancreatic cancer with mechanisms related to oncological disease. A better description of the characteristics of cerebrovascular events would help better understand the pathogeny and protect vulnerable patients. We thus conducted a descriptive analysis of clinical, biological, and radiological features of patients from our centers and literature. We reviewed consecutive cases of patients who presented cerebrovascular events and pancreatic cancer in 4 stroke units in Lorrain (France) between January 1, 2009 and March 31, 2015, and all reported cases of literature. We identified 17 cases in our centers and 18 reported cases. Fifty-seven per cent of patients were male. Median age was 63 ± 14 years and ranged from 23 to 81 years. All cerebral events were ischemic. At the onset of stroke, pancreatic cancer had already been diagnosed in 59% of the patients in our centers for a mean time of 5.4 months. Five of them (29%) were being treated with gemcitabine and 2 (12%) with folfirinox. Adenocarcinoma at metastatic stage was reported in 82% of cases overall. Brain imaging revealed disseminated infarctions in 64%. High median levels of D-dimer (7600 ± 5 × 10(7) μg/L), C-reactive protein (63 ± 43 mg/L), and elevated prothrombin time (19 ± 6 seconds) were found. Thirty-six per cent of patients explored with echocardiography were diagnosed with nonbacterial thrombotic endocarditis. Ten of our patients received anticoagulant therapy as secondary stroke prevention without any documented recurrence. Nevertheless, outcome was poor with a median survival time of 28 ± 14 days after stroke onset. Cerebral ischemic events occur at advanced stages of pancreatic cancer, most likely by a thromboembolic mechanism. Disseminated infarctions and high D-dimer, C-reactive protein levels, and a high prothrombin time are the most constant characteristics found in this context. All patients should be screened for nonbacterial thrombotic endocarditis as this etiology supports the use of anticoagulant therapy.
format Online
Article
Text
id pubmed-4937929
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Wolters Kluwer Health
record_format MEDLINE/PubMed
spelling pubmed-49379292016-08-18 Cerebral ischemic events in patients with pancreatic cancer: A retrospective cohort study of 17 patients and a literature review Bonnerot, Mathieu Humbertjean, Lisa Mione, Gioia Lacour, Jean-Christophe Derelle, Anne-Laure Sanchez, Jean-Charles Riou-Comte, Nolwenn Richard, Sébastien Medicine (Baltimore) 5300 Stroke is a dramatic complication of pancreatic cancer with mechanisms related to oncological disease. A better description of the characteristics of cerebrovascular events would help better understand the pathogeny and protect vulnerable patients. We thus conducted a descriptive analysis of clinical, biological, and radiological features of patients from our centers and literature. We reviewed consecutive cases of patients who presented cerebrovascular events and pancreatic cancer in 4 stroke units in Lorrain (France) between January 1, 2009 and March 31, 2015, and all reported cases of literature. We identified 17 cases in our centers and 18 reported cases. Fifty-seven per cent of patients were male. Median age was 63 ± 14 years and ranged from 23 to 81 years. All cerebral events were ischemic. At the onset of stroke, pancreatic cancer had already been diagnosed in 59% of the patients in our centers for a mean time of 5.4 months. Five of them (29%) were being treated with gemcitabine and 2 (12%) with folfirinox. Adenocarcinoma at metastatic stage was reported in 82% of cases overall. Brain imaging revealed disseminated infarctions in 64%. High median levels of D-dimer (7600 ± 5 × 10(7) μg/L), C-reactive protein (63 ± 43 mg/L), and elevated prothrombin time (19 ± 6 seconds) were found. Thirty-six per cent of patients explored with echocardiography were diagnosed with nonbacterial thrombotic endocarditis. Ten of our patients received anticoagulant therapy as secondary stroke prevention without any documented recurrence. Nevertheless, outcome was poor with a median survival time of 28 ± 14 days after stroke onset. Cerebral ischemic events occur at advanced stages of pancreatic cancer, most likely by a thromboembolic mechanism. Disseminated infarctions and high D-dimer, C-reactive protein levels, and a high prothrombin time are the most constant characteristics found in this context. All patients should be screened for nonbacterial thrombotic endocarditis as this etiology supports the use of anticoagulant therapy. Wolters Kluwer Health 2016-07-01 /pmc/articles/PMC4937929/ /pubmed/27368015 http://dx.doi.org/10.1097/MD.0000000000004009 Text en Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 5300
Bonnerot, Mathieu
Humbertjean, Lisa
Mione, Gioia
Lacour, Jean-Christophe
Derelle, Anne-Laure
Sanchez, Jean-Charles
Riou-Comte, Nolwenn
Richard, Sébastien
Cerebral ischemic events in patients with pancreatic cancer: A retrospective cohort study of 17 patients and a literature review
title Cerebral ischemic events in patients with pancreatic cancer: A retrospective cohort study of 17 patients and a literature review
title_full Cerebral ischemic events in patients with pancreatic cancer: A retrospective cohort study of 17 patients and a literature review
title_fullStr Cerebral ischemic events in patients with pancreatic cancer: A retrospective cohort study of 17 patients and a literature review
title_full_unstemmed Cerebral ischemic events in patients with pancreatic cancer: A retrospective cohort study of 17 patients and a literature review
title_short Cerebral ischemic events in patients with pancreatic cancer: A retrospective cohort study of 17 patients and a literature review
title_sort cerebral ischemic events in patients with pancreatic cancer: a retrospective cohort study of 17 patients and a literature review
topic 5300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4937929/
https://www.ncbi.nlm.nih.gov/pubmed/27368015
http://dx.doi.org/10.1097/MD.0000000000004009
work_keys_str_mv AT bonnerotmathieu cerebralischemiceventsinpatientswithpancreaticcanceraretrospectivecohortstudyof17patientsandaliteraturereview
AT humbertjeanlisa cerebralischemiceventsinpatientswithpancreaticcanceraretrospectivecohortstudyof17patientsandaliteraturereview
AT mionegioia cerebralischemiceventsinpatientswithpancreaticcanceraretrospectivecohortstudyof17patientsandaliteraturereview
AT lacourjeanchristophe cerebralischemiceventsinpatientswithpancreaticcanceraretrospectivecohortstudyof17patientsandaliteraturereview
AT derelleannelaure cerebralischemiceventsinpatientswithpancreaticcanceraretrospectivecohortstudyof17patientsandaliteraturereview
AT sanchezjeancharles cerebralischemiceventsinpatientswithpancreaticcanceraretrospectivecohortstudyof17patientsandaliteraturereview
AT rioucomtenolwenn cerebralischemiceventsinpatientswithpancreaticcanceraretrospectivecohortstudyof17patientsandaliteraturereview
AT richardsebastien cerebralischemiceventsinpatientswithpancreaticcanceraretrospectivecohortstudyof17patientsandaliteraturereview