Abstract
Patients with prostate cancer have an increased risk of stroke, but their absolute rate of stroke depends on age and comorbid conditions. The Charlson Comorbidity Index Score (CCIS) is a widely accepted measure for risk adjustment in administrative claims data sets. This study assesses the predictive value of CHADS2 scores and CCIS for stroke among patients with prostate cancer. The study was conducted based on data taken from Taiwan's National Health Insurance Research Database (NHIRD). We identified a total of 5414 participants with nonatrial fibrillation (AF) prostate cancer diagnoses who underwent radical prostatectomy between 1997 and 2011. CHADS2 scores and CCIS were used to stratify the 5-year ischemic stroke risk. All participants were followed from the date of enrollment until ischemic stroke, death, or the end of the 5-year follow-up period. The 5-year risk of ischemic stroke in the present study was 1.7%. Ischemic stroke has a better correlation with CHADS2 (CHADS2 score = 0 to 1: 0.02%, CHADS2 score = 2 to 3: 13.9%, CHADS2 score ≥ 4: 44.4%; AUC = 0.978) than CCIS (CCIS = 0 to 1: 1.6%, CCIS = 2 to 3: 1.7%, CCIS ≥ 4: 3.8%; AUC = 0.520). Our results show that patients with prostate cancer who underwent radical prostatectomy show significantly higher risk of ischemic stroke in high CHADS2 score patients, and the CHADS2 score could be applied for ischemic stroke prediction. Cardiovascular risks evaluation and management are suggested for prostate cancer patients with higher CHADS2 score.
Highlights
Prostate cancer is a common noncutaneous malignancy in men
The National Health Insurance Research Database (NHIRD) records 5414 patients diagnosed with prostate cancer undergoing radical prostatectomy from 1997 to 2011 within the NHIRD
We provide the general calculation for the rate of incidence as well as a risk assessment for ischemic stroke in cases following radical prostatectomy for prostate cancer
Summary
Prostate cancer is a common noncutaneous malignancy in men. Radical prostatectomy reduces cancer-specific mortality among men with localized prostate cancer; important questions regarding long-term benefit remain [1,2,3]. Because prostate cancer is typically diagnosed in elderly men, a significant proportion of patients have comorbidities that result in a high rate of noncancer- related mortality [3]. This raises the need for a test which can identify patients that enjoy long-term benefits from radical prostatectomy. Substantial experimental data suggest that the coagulation system is implicated in multiple cancer pathways, including tumor proliferation, angiogenesis, apoptosis, and metastasis [9, 10] These reports implied that malignant disease and hemostasis interact to produce thrombosis, leading to ischemic stroke which can result in disability or even death. It is important to determine whether patients who underwent radical prostatectomy for prostate cancer have an elevated risk of ischemic stroke
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