학술논문
Cancer screening in hospitalized ischemic stroke patients: a multicenter study focused on multiparametric analysis to improve management of occult cancers
Document Type
Academic Journal
Author
Fang, Jie; Wu, Jielong; Hong, Ganji; Zheng, Liangcheng; Yu, Lu; Liu, Xiuping; Lin, Pan; Yu, Zhenzhen; Chen, Dan; Lin, Qing; Jing, Chuya; Zhang, Qiuhong; Wang, Chen; Zhao, Jiedong; Yuan, Xiaodong; Wu, Chunfang; Zhang, Zhaojie; Guo, Mingwei; Zhang, Junde; Zheng, Jingjing; Lei, Aidi; Zhang, Tengkun; Lan, Quan; Kong, Lingsheng; Wang, Xinrui; Wang, Zhanxiang; Ma, Qilin
Source
The EPMA Journal. February 19, 2024
Subject
Language
English
ISSN
1878-5077
Abstract
Author(s): Jie Fang[sup.1,2,3,4,5,6,7], Jielong Wu[sup.1,7,8], Ganji Hong[sup.9], Liangcheng Zheng[sup.1,2,3,4,5,6], Lu Yu[sup.10], Xiuping Liu[sup.11], Pan Lin[sup.12], Zhenzhen Yu[sup.13], Dan Chen[sup.14], Qing Lin[sup.1,2,3,4,5,6], Chuya Jing[sup.1,2,3,4,5,6], Qiuhong Zhang[sup.1,2,3,4,5,6], Chen Wang[sup.1,2,3,4,5,6], Jiedong Zhao[sup.15], Xiaodong [...]
Background/aims The reciprocal promotion of cancer and stroke occurs due to changes in shared risk factors, such as metabolic pathways and molecular targets, creating a 'vicious cycle.' Cancer plays a direct or indirect role in the pathogenesis of ischemic stroke (IS), along with the reactive medical approach used in the treatment and clinical management of IS patients, resulting in clinical challenges associated with occult cancer in these patients. The lack of reliable and simple tools hinders the effectiveness of the predictive, preventive, and personalized medicine (PPPM/3PM) approach. Therefore, we conducted a multicenter study that focused on multiparametric analysis to facilitate early diagnosis of occult cancer and personalized treatment for stroke associated with cancer. Methods Admission routine clinical examination indicators of IS patients were retrospectively collated from the electronic medical records. The training dataset comprised 136 IS patients with concurrent cancer, matched at a 1:1 ratio with a control group. The risk of occult cancer in IS patients was assessed through logistic regression and five alternative machine-learning models. Subsequently, select the model with the highest predictive efficacy to create a nomogram, which is a quantitative tool for predicting diagnosis in clinical practice. Internal validation employed a ten-fold cross-validation, while external validation involved 239 IS patients from six centers. Validation encompassed receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and comparison with models from prior research. Results The ultimate prediction model was based on logistic regression and incorporated the following variables: regions of ischemic lesions, multiple vascular territories, hypertension, D-dimer, fibrinogen (FIB), and hemoglobin (Hb). The area under the ROC curve (AUC) for the nomogram was 0.871 in the training dataset and 0.834 in the external test dataset. Both calibration curves and DCA underscored the nomogram's strong performance. Conclusions The nomogram enables early occult cancer diagnosis in hospitalized IS patients and helps to accurately identify the cause of IS, while the promotion of IS stratification makes personalized treatment feasible. The online nomogram based on routine clinical examination indicators of IS patients offered a cost-effective platform for secondary care in the framework of PPPM. Keywords: Ischemic stroke, Occult cancer, Machine-learning, Nomogram, Admission screening, External validation, Multicenter observational study, Predictive Preventive Personalized medicine (PPPM / 3PM)
Background/aims The reciprocal promotion of cancer and stroke occurs due to changes in shared risk factors, such as metabolic pathways and molecular targets, creating a 'vicious cycle.' Cancer plays a direct or indirect role in the pathogenesis of ischemic stroke (IS), along with the reactive medical approach used in the treatment and clinical management of IS patients, resulting in clinical challenges associated with occult cancer in these patients. The lack of reliable and simple tools hinders the effectiveness of the predictive, preventive, and personalized medicine (PPPM/3PM) approach. Therefore, we conducted a multicenter study that focused on multiparametric analysis to facilitate early diagnosis of occult cancer and personalized treatment for stroke associated with cancer. Methods Admission routine clinical examination indicators of IS patients were retrospectively collated from the electronic medical records. The training dataset comprised 136 IS patients with concurrent cancer, matched at a 1:1 ratio with a control group. The risk of occult cancer in IS patients was assessed through logistic regression and five alternative machine-learning models. Subsequently, select the model with the highest predictive efficacy to create a nomogram, which is a quantitative tool for predicting diagnosis in clinical practice. Internal validation employed a ten-fold cross-validation, while external validation involved 239 IS patients from six centers. Validation encompassed receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and comparison with models from prior research. Results The ultimate prediction model was based on logistic regression and incorporated the following variables: regions of ischemic lesions, multiple vascular territories, hypertension, D-dimer, fibrinogen (FIB), and hemoglobin (Hb). The area under the ROC curve (AUC) for the nomogram was 0.871 in the training dataset and 0.834 in the external test dataset. Both calibration curves and DCA underscored the nomogram's strong performance. Conclusions The nomogram enables early occult cancer diagnosis in hospitalized IS patients and helps to accurately identify the cause of IS, while the promotion of IS stratification makes personalized treatment feasible. The online nomogram based on routine clinical examination indicators of IS patients offered a cost-effective platform for secondary care in the framework of PPPM. Keywords: Ischemic stroke, Occult cancer, Machine-learning, Nomogram, Admission screening, External validation, Multicenter observational study, Predictive Preventive Personalized medicine (PPPM / 3PM)