The Risk of Ischemic Stroke in Head and Neck Cancer Patients and Those Who Were Treated with Radiotherapy: A Population-Based Cohort Study

Author:

Yeh Tzu-Lin12ORCID,Hsieh Cheng-Tzu2ORCID,Hsu Hsin-Yin234,Tsai Ming-Chieh245,Wang Chia-Chun6,Lin Chuan-Yi27ORCID,Hsiao Bo-Yu2,Jhuang Jing-Rong2,Chiang Chun-Ju28,Lee Wen-Chung289ORCID,Chien Kuo-Liong210ORCID

Affiliation:

1. 1Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.

2. 2Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.

3. 3Department of Family Medicine, Taipei MacKay Memorial Hospital, Taipei, Taiwan.

4. 4Department of Medical Research, MacKay Memorial College, New Taipei City, Taiwan.

5. 5Division of Endocrinology, Department of Internal Medicine, MacKay Memorial Hospital, Tamsui Branch, New Taipei City, Taiwan.

6. 6Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.

7. 7Department of Otolaryngology, Lotung Poh-Ai Hospital, Yilan, Taiwan.

8. 8Taiwan Cancer Registry, Taipei, Taiwan.

9. 9Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan.

10. 10Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Abstract

Abstract Background: To investigate the standardized incidence ratios (SIR) of stroke in patients with head and neck cancer and their relationship to radiotherapy. Methods: Patients with head and neck cancer ages 20–85 years were enrolled from 2007 to 2016 using the Taiwan Cancer Registry. The study endpoint was fatal and non-fatal ischemic stroke, ascertained by the National Health Insurance Research Database. Age- and sex-adjusted SIRs, categorized by 10-year age standardization, were used to compare the patients with head and neck cancer with a randomly selected 2,000,000 general population. We compared the risk of stroke in patients with head and neck cancer who received radiotherapy or surgery alone. Multivariable adjusted hazard ratios (HR) and 95% confidence intervals (CI) were obtained from Cox regression analysis with competing risk. Results: Among 41,266 patients (mean age, 54.1 years; men, 90.6%) in the median follow-up period of 3.9 years, 1,407 strokes occurred. Compared with the general population, the overall SIR of stroke was 1.37 (95% CI, 1.30–1.44) in patients with head and neck cancer. In patients with head and neck cancer, the fully adjusted HR of stroke in those who received radiotherapy was 0.96 (95% CI, 0.83–1.10), compared with those who received surgery alone. Conclusions: Patients with head and neck cancer had a higher risk of fatal or non-fatal ischemic stroke. The risk of stroke was not higher in patients initially treated with radiotherapy. Impact: Oncologists should emphasize stroke prevention in all patients with head and neck cancer, not only in those who received radiotherapy.

Funder

Health Promotion Administration, Ministry of Health and Welfare

Ministry of Science and Technology in Taiwan

Publisher

American Association for Cancer Research (AACR)

Subject

Oncology,Epidemiology

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