Global Incidence, Mortality, and Risk Factors of Stroke in Multi-Modality Head and Neck Cancer Treatment—A Systematic Review and Meta-Analysis

IF 2.2 3区医学 Q1 OTORHINOLARYNGOLOGY Head and Neck-Journal for the Sciences and Specialties of the Head and Neck Pub Date : 2025-02-12 DOI:10.1002/hed.28109

Srivatsa Surya Vasudevan, Elise Ericksen, Victor Albornoz, Elizabeth Bryan, Lindsay Olinde, Cherie-Ann O. Nathan

{"title":"Global Incidence, Mortality, and Risk Factors of Stroke in Multi-Modality Head and Neck Cancer Treatment—A Systematic Review and Meta-Analysis","authors":"Srivatsa Surya Vasudevan, Elise Ericksen, Victor Albornoz, Elizabeth Bryan, Lindsay Olinde, Cherie-Ann O. Nathan","doi":"10.1002/hed.28109","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Head and neck cancer (HNC) due to its nature and proximity to essential vasculature, along with different treatments, can lead to stroke, significantly contributing to morbidity and mortality. Our aim is to systematically evaluate the association of stroke incidence, mortality, and predictors with HNC treatment.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Pubmed, Web of Science, Embase, and ScienceDirect were searched from inception to July 2024 for articles reporting stroke incidences, mortality, or associated risk factors following treatment in HNC patients. A random-effects meta-analysis assessed cumulative incidence and mortality rates with proportional analysis and risk factors using hazard ratios (HRs) associated with HNC treatment. Subgroup analyses of incidence and mortality were conducted for pre- and post-2010 periods, reflecting changes in stroke protocols.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Out of 1561 studies, 69 studies with 258 850 HNC patients were included. The global cumulative incidence of stroke in HNC was 4.1% (95% CI: 3.3%–5.0%), with similar rates before and after 2010 (4.4% vs. 4.0%). In patients undergoing chemoradiotherapy (CRT), stroke incidence was 4.9% (95% CI: 3.5%–6.7%) with a median time to first stroke of 45 months (range: 14–51.7 months). Following radiation therapy (RT), stroke incidence was 3.8% (95% CI: 2.7%–5.3%) with a median time to stroke of 36 months (range: 6.8–130 months). The incidence rates of stroke in HNC patients were higher compared to the general population (HR: 1.69, 95% CI: 1.24–2.31, <i>p</i> = 0.001). Stroke mortality decreased from 28.5% (95% CI: 11.6%–54.9%) pre-2010 to 14.5% (95% CI: 11.6%–17.9%) 2010–2024. Stroke mortality was 39.3% (95% CI: 17.8%–66.0%) post-CRT and 21% (95% CI: 7.2%–47.7%) post-RT. Hypertension (HR = 1.75), diabetes (HR = 1.71), and age > 65 (HR = 2.17) increased stroke risk (<i>p</i> < 0.0001 for all). Geographically, South Korea (6.6%) had the highest incidence of stroke.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>This is the first systematic review to analyze the association between stroke and HNC treatment. Stroke mortality decreased from 28.5% to 14.5% (pre-2010 vs. 2010–2024), with the highest mortality in the CRT group (39.3%). Given that stroke occurs 36–45 months after CRT, a screening protocol within 3–4 years is crucial.</p>\n </section>\n </div>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":"47 5","pages":"1520-1540"},"PeriodicalIF":2.2000,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/hed.28109","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Head and neck cancer (HNC) due to its nature and proximity to essential vasculature, along with different treatments, can lead to stroke, significantly contributing to morbidity and mortality. Our aim is to systematically evaluate the association of stroke incidence, mortality, and predictors with HNC treatment.

Methods

Pubmed, Web of Science, Embase, and ScienceDirect were searched from inception to July 2024 for articles reporting stroke incidences, mortality, or associated risk factors following treatment in HNC patients. A random-effects meta-analysis assessed cumulative incidence and mortality rates with proportional analysis and risk factors using hazard ratios (HRs) associated with HNC treatment. Subgroup analyses of incidence and mortality were conducted for pre- and post-2010 periods, reflecting changes in stroke protocols.

Results

Out of 1561 studies, 69 studies with 258 850 HNC patients were included. The global cumulative incidence of stroke in HNC was 4.1% (95% CI: 3.3%–5.0%), with similar rates before and after 2010 (4.4% vs. 4.0%). In patients undergoing chemoradiotherapy (CRT), stroke incidence was 4.9% (95% CI: 3.5%–6.7%) with a median time to first stroke of 45 months (range: 14–51.7 months). Following radiation therapy (RT), stroke incidence was 3.8% (95% CI: 2.7%–5.3%) with a median time to stroke of 36 months (range: 6.8–130 months). The incidence rates of stroke in HNC patients were higher compared to the general population (HR: 1.69, 95% CI: 1.24–2.31, p = 0.001). Stroke mortality decreased from 28.5% (95% CI: 11.6%–54.9%) pre-2010 to 14.5% (95% CI: 11.6%–17.9%) 2010–2024. Stroke mortality was 39.3% (95% CI: 17.8%–66.0%) post-CRT and 21% (95% CI: 7.2%–47.7%) post-RT. Hypertension (HR = 1.75), diabetes (HR = 1.71), and age > 65 (HR = 2.17) increased stroke risk (p < 0.0001 for all). Geographically, South Korea (6.6%) had the highest incidence of stroke.

Conclusion

This is the first systematic review to analyze the association between stroke and HNC treatment. Stroke mortality decreased from 28.5% to 14.5% (pre-2010 vs. 2010–2024), with the highest mortality in the CRT group (39.3%). Given that stroke occurs 36–45 months after CRT, a screening protocol within 3–4 years is crucial.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

多模式头颈癌治疗中卒中的全球发病率、死亡率和危险因素——系统回顾和荟萃分析

背景：头颈癌（HNC）由于其性质和接近基本脉管系统，以及不同的治疗方法，可导致中风，显著促进发病率和死亡率。我们的目的是系统地评估脑卒中发病率、死亡率和预测因素与HNC治疗的关系。方法：检索Pubmed、Web of Science、Embase和ScienceDirect从成立到2024年7月报道HNC患者治疗后卒中发病率、死亡率或相关危险因素的文章。随机效应荟萃分析通过比例分析评估累积发病率和死亡率，并使用危险比（hr）评估与HNC治疗相关的危险因素。对2010年前和2010年后的发病率和死亡率进行了亚组分析，反映了卒中方案的变化。结果：在1561项研究中，69项研究纳入了258 850例HNC患者。HNC卒中的全球累积发病率为4.1% (95% CI: 3.3%-5.0%)， 2010年前后的发生率相似（4.4%对4.0%）。在接受放化疗（CRT）的患者中，卒中发生率为4.9% (95% CI: 3.5%-6.7%)，至首次卒中的中位时间为45个月（范围：14-51.7个月）。放射治疗（RT）后，卒中发生率为3.8% (95% CI: 2.7%-5.3%)，中位卒中时间为36个月（范围：6.8-130个月）。HNC患者的卒中发生率高于一般人群（HR: 1.69, 95% CI: 1.24-2.31, p = 0.001）。2010-2024年，脑卒中死亡率从2010年前的28.5% （95% CI: 11.6%-54.9%）降至14.5% （95% CI: 11.6%-17.9%）。crt后卒中死亡率为39.3% (95% CI: 17.8%-66.0%)， rt后为21% （95% CI: 7.2%-47.7%）。高血压（HR = 1.75）、糖尿病（HR = 1.71）和年龄（HR = 2.17）增加了脑卒中风险(p)。结论：这是第一个分析脑卒中与HNC治疗之间关系的系统综述。脑卒中死亡率从28.5%降至14.5%（2010年前与2010-2024年），CRT组死亡率最高（39.3%）。考虑到中风发生在CRT后36-45个月，3-4年内的筛查方案至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck 医学-耳鼻喉科学

CiteScore

7.00

自引率

6.90%

发文量

278

审稿时长

1.6 months

期刊介绍： Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.