Cancer-associated
ischemic stroke (CAS) refers to a hypercoagulation disorder related to malignant
tumors, especially
adenocarcinoma.
Carbohydrate antigen (CA) 125 is a mucinous
serum marker that might reflect hypercoagulation status, but the association between CA 125 and CAS is unclear across various types of
cancer. The aim of this study was to investigate the associations among
tumor markers, coagulation markers, and clinical factors in
acute ischemic stroke (AIS) patients with active
cancer. Consecutive AIS patients with active
cancer (a diagnosis or ongoing active
therapy for
cancer within 6 months) were prospectively enrolled at four hospitals.
D-dimer,
C-reactive protein (CRP),
carcinoembryonic antigen (CEA), CA19-9, and CA 125 levels were measured. Of 120 AIS patients with active
cancer, 47 were diagnosed with CAS. CA 125 had the strongest correlations with
D-dimer and CRP (ρ = 0.543, p < 0.001 and ρ = 0.452, p < 0.001, respectively). The areas under the receiver-operating characteristic curves for the diagnosis of CAS were 0.812 (95% CI 0.718-0.878) for CA 125, 0.714 (95% CI 0.602-0.801) for CEA, and 0.663 (95% CI 0.552-0.759) for CA 19-9. Multivariable analysis revealed that CA 125 levels in the highest quartile (OR 2.91, 95% CI 1.68-5.53), multiple lesions in multiple vascular territories observed on diffusion-weighted imaging, the absence of
dyslipidemia, and the absence of
atrial fibrillation were independently associated with CAS. Increased CA 125 levels, which indicate
hypercoagulability, were useful for diagnosing CAS in AIS patients with active
cancer.