Abstract
Although pancreatic cancer (PC) patients have a high risk of cancer-associated thrombosis, less is known about the frequency, treatment, recurrence and prognosis in PC patients who experienced cerebral infarction (CI) associated with Trousseau's Syndrome (TS), a hyprercoagulated state with cancer. We therefore investigated the clinical outcomes of CI in PC patients. We retrospectively reviewed the medical records of patients with advanced PC who were treated at St. Marianna University School of Medicine Hospital from January 2015 to February 2020 and retrieved information regarding age, sex, performance status (PS), onset time, symptoms, antithrombotic treatment, recurrence and overall survival (OS) after CI associated with TS. In 177 patients, CI was diagnosed in 11 (6.2%) patients [median age, 71 (52-79) years; male/female, 6/5; PS, 0-2/3-4, 1/10; clinical stage, 4/recurrence, 10/1; medical history, none/diabetes/hyperlipidemia, 0/1/1]. The median D-dimer level was 13 μg/mL (range, 1.9-38.9). Three out of 11 (27.3%) patients had history of venous thromboembolism. Symptoms at the onset were 7 paralysis, 3 aphasia, 4 dysarthria, and 3 disorientation. CI occurred before therapy in 1 patient, during receiving chemotherapy in 4 patients, and on palliation in 6 patients. Initial anticoagulation included 6 heparin (1 patient underwent thrombectomy at the same time) and 1 apixaban and other 4 patients were treated without anticoagulation due to the high risk of bleeding such as DIC or gastrointestinal perforations. Two out of 11 (18.2%) patients, one received aspirin and another did not receive anticoagulant therapy, had a recurrent CI. The median OS after CI onset was 1.8 months (95%CI 0.5-3.1). Approximately 6% patients with advanced PC developed CI associated TS, and their general condition and prognosis were very poor. The development of biomarkers and optimal treatment strategies are desired.
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