High 1-year risk of stroke in patients with hepatocellular carcinoma: a nationwide registry-based cohort study

Sci Rep. 2021 May 17;11(1):10444. doi: 10.1038/s41598-021-89867-0.

Abstract

Patients with hepatocellular carcinoma (HCC) might be more vulnerable to develop stroke than other cancer patients because of HCC-associated coagulation dysfunction. However, limited studies have investigated the relationship between HCC and stroke. This nationwide population-based cohort study enrolled all patients with HCC diagnosed between 2011 and 2015 from the Taiwan Cancer Registry and Taiwan National Health Insurance Research Database; an age- and sex-matched cohort without cancer was included. The primary outcome was the 1-year risk for first-ever stroke after the index date. The Fine and Gray competing risk regression model was used to estimate the 1-year stroke risk with adjusted hazard ratios (aHRs). After propensity score matching, each cohort has 18,506 patients with similar baseline characteristics. Compared with the cancer-free cohort, the aHRs in the HCC cohort for overall, ischemic, and hemorrhagic strokes were 1.59 [95% confidence interval (CI), 1.35-1.88], 1.38 [95% CI, 1.15-1.65], and 2.62 [95% CI, 1.79-3.84], respectively. On subgroup analysis, HCC patients without cirrhosis, those with stage 3 or 4 cancer had a higher stroke risk than cancer-free cohort. Therefore, stroke prevention should be considered in patients with HCC, especially in those without cirrhosis and with stage 3 or 4 cancer.

MeSH terms

  • Aged
  • Carcinoma, Hepatocellular / complications
  • Carcinoma, Hepatocellular / diagnosis
  • Carcinoma, Hepatocellular / epidemiology*
  • Case-Control Studies
  • Cohort Studies
  • Female
  • Humans
  • Liver Neoplasms / complications
  • Liver Neoplasms / diagnosis
  • Liver Neoplasms / epidemiology*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Propensity Score
  • Proportional Hazards Models
  • Registries / statistics & numerical data
  • Risk Assessment / statistics & numerical data
  • Risk Factors
  • Stroke / epidemiology*
  • Stroke / etiology
  • Stroke / prevention & control
  • Taiwan