Background: Data on clinical characteristics and outcome of patients with intracerebral hemorrhage (ICH) and concomitant systemic cancer disease are very limited. Methods: Nine hundred and seventy three consecutive primary ICH patients were analyzed using our prospective institutional registry over a period of 9 years (2006-2014). We compared clinical and radiological parameters as well as outcome - scored using the modified Rankin Scale (mRS) and analyzed in a dichotomized fashion as favorable outcome (mRS = 0-3) and unfavorable outcome (mRS = 4-6) - of ICH patients with and without cancer. Relevant imbalances in baseline clinical and radiological characteristics were adjusted using propensity score (PS) matching. Results: Prevalence of systemic cancer among patients with ICH was 8.5% (83/973). ICH patients with cancer were older (77 [70-82] vs. 72 [63-80] years; p = 0.002), had more often prior renal dysfunction (19/83 [22.9%] vs.107/890 [12.0%]; p = 0.005), and smaller hemorrhage volumes (10.1 [4.8-24.3] vs. 15.3 [5.4-42.9] mL; p = 0.017). After PS-matching there were no significant differences neither in mortality nor in functional outcome both at 3 months (mortality: 33/81 [40.7%] vs. 55/158 [34.8%]; p = 0.368; mRS = 0-3: 28/81 [34.6%] vs. 52/158 [32.9%]; p = 0.797) and 12 months (mortality: 39/78 [50.0%] vs. 70/150 [46.7%]; p = 0.633; mRS = 0-3: 25/78 [32.1%] vs. 53/150 [35.3%]; p = 0.620) among patients with and without concomitant systemic cancer. ICH volume tended to be highest in patients with hematooncologic malignancy and smallest in urothelial cancer. Conclusions: Patients with ICH and concomitant systemic cancer on average are older; however, they show smaller ICH volumes compared to patients without cancer. Yet, mortality and functional outcome is not different in ICH patients with and without cancer. Thus, the clinical history or the de novo diagnosis of concomitant malignancies in ICH patients should not lead to unjustified treatment restrictions.

GBD 2015 DALYs and HALE Collaborators: Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388:1603-1658.
Howard G, Goff DC: Population shifts and the future of stroke: forecasts of the future burden of stroke. Ann N Y Acad Sci 2012;1268:14-20.
van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ: Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 2010;9:167-176.
GBD 2015 Mortality and Causes of Death Collaborators: Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388:1459-1544.
Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA: Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 2009;27:2758-2765.
Reulen RC, Winter DL, Frobisher C, Lancashire ER, Stiller CA, Jenney ME, Skinner R, Stevens MC, Hawkins MM: Long-term cause-specific mortality among survivors of childhood cancer. Jama 2010;304:172-179.
Navi BB, Singer S, Merkler AE, Cheng NT, Stone JB, Kamel H, Iadecola C, Elkind MS, DeAngelis LM: Recurrent thromboembolic events after ischemic stroke in patients with cancer. Neurology 2014;83:26-33.
Qureshi AI, Malik AA, Saeed O, Adil MM, Rodriguez GJ, Suri MF: Incident cancer in a cohort of 3,247 cancer diagnosis free ischemic stroke patients. Cerebrovasc Dis 2015;39:262-268.
Navi BB, Reichman JS, Berlin D, Reiner AS, Panageas KS, Segal AZ, DeAngelis LM: Intracerebral and subarachnoid hemorrhage in patients with cancer. Neurology 2010;74:494-501.
Ryu JA, Lee D, Yang JH, Chung CR, Park CM, Suh GY, Jeon K: Spontaneous intracranial haemorrhage in critically ill patients with malignancies. Support Care Cancer 2016;24:2971-2978.
Murthy SB, Shastri A, Merkler AE, Hanley DF, Ziai WC, Fink ME, Iadecola C, Kamel H, Navi BB: Intracerebral hemorrhage outcomes in patients with systemic cancer. J Stroke Cerebrovasc Dis 2016;25:2918-2924.
Becker KJ, Baxter AB, Cohen WA, Bybee HM, Tirschwell DL, Newell DW, Winn HR, Longstreth WT Jr: Withdrawal of support in intracerebral hemorrhage may lead to self-fulfilling prophecies. Neurology 2001;56:766-772.
van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J: Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604-607.
Stevens PE, Levin A: Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 2013;158:825-830.
Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY: A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 2010;138:1093-1100.
Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M, Rickles FR, Julian JA, Haley S, Kovacs MJ, Gent M: Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003;349:146-153.
Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, Moy CS, Silbergleit R, Steiner T, Suarez JI, Toyoda K, Wang Y, Yamamoto H, Yoon BW: Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med 2016;375:1033-1043.
Ziai WC, Tuhrim S, Lane K, McBee N, Lees K, Dawson J, Butcher K, Vespa P, Wright DW, Keyl PM, Mendelow AD, Kase C, Wijman C, Lapointe M, John S, Thompson R, Thompson C, Mayo S, Reilly P, Janis S, Awad I, Hanley DF: A multicenter, randomized, double-blinded, placebo-controlled phase III study of Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Hemorrhage (CLEAR III). Int J Stroke 2014;9:536-542.
Banks JL, Marotta CA: Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke 2007;38:1091-1096.
Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, Khoury J: The ABCs of measuring intracerebral hemorrhage volumes. Stroke 1996;27:1304-1305.
Huttner HB, Steiner T, Hartmann M, Kohrmann M, Juettler E, Mueller S, Wikner J, Meyding-Lamade U, Schramm P, Schwab S, Schellinger PD: Comparison of ABC/2 estimation technique to computer-assisted planimetric analysis in warfarin-related intracerebral parenchymal hemorrhage. Stroke 2006;37:404-408.
Burgess RE, Warach S, Schaewe TJ, Copenhaver BR, Alger JR, Vespa P, Martin N, Saver JL, Kidwell CS: Development and validation of a simple conversion model for comparison of intracerebral hemorrhage volumes measured on CT and gradient recalled echo MRI. Stroke 2008;39:2017-2020.
Brott T, Broderick J, Kothari R, Barsan W, Tomsick T, Sauerbeck L, Spilker J, Duldner J, Khoury J: Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 1997;28:1-5.
Kuramatsu JB, Gerner ST, Schellinger PD, Glahn J, Endres M, Sobesky J, Flechsenhar J, Neugebauer H, Juttler E, Grau A, Palm F, Rother J, Michels P, Hamann GF, Huwel J, Hagemann G, Barber B, Terborg C, Trostdorf F, Bazner H, Roth A, Wohrle J, Keller M, Schwarz M, Reimann G, Volkmann J, Mullges W, Kraft P, Classen J, Hobohm C, Horn M, Milewski A, Reichmann H, Schneider H, Schimmel E, Fink GR, Dohmen C, Stetefeld H, Witte O, Gunther A, Neumann-Haefelin T, Racs AE, Nueckel M, Erbguth F, Kloska SP, Dorfler A, Kohrmann M, Schwab S, Huttner HB: Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. JAMA 2015;313:824-836.
Drake C, Fisher L: Prognostic models and the propensity score. Int J Epidemiol 1995;24:183-187.
Forti P, Maioli F, Domenico Spampinato M, Barbara C, Nativio V, Coveri M, Zoli M, Simonetti L, Di Pasquale G, Procaccianti G: The effect of age on characteristics and mortality of intracerebral hemorrhage in the oldest-old. Cerebrovasc Dis 2016;42:485-492.
Zoller B, Ji J, Sundquist J, Sundquist K: Risk of haemorrhagic and ischaemic stroke in patients with cancer: a nationwide follow-up study from Sweden. Eur J Cancer 2012;48:1875-1883.
Khasraw M, Posner JB: Neurological complications of systemic cancer. Lancet Neurol 2010;9:1214-1227.
Dearborn JL, Urrutia VC, Zeiler SR: Stroke and cancer- a complicated relationship. J Neurol Transl Neurosci 2014;2:1039.
Shearer MJ: Vitamin K in parenteral nutrition. Gastroenterology 2009;137:S105-S118.
Dibaise JK, Young RJ, Vanderhoof JA: Enteric microbial flora, bacterial overgrowth, and short-bowel syndrome. Clin Gastroenterol Hepatol 2006;4:11-20.
Kuramatsu JB, Gerner ST, Lucking H, Kloska SP, Schellinger PD, Kohrmann M, Huttner HB: Anemia is an independent prognostic factor in intracerebral hemorrhage: an observational cohort study. Crit Care 2013;17:R148.
Beuscher VD, Kuramatsu JB, Gerner ST, Kohn J, Lucking H, Kloska SP, Huttner HB: Functional long-term outcome after left- versus right-sided intracerebral hemorrhage. Cerebrovasc Dis 2017;43:117-123.
Giede-Jeppe A, Bobinger T, Gerner ST, Sembill JA, Sprugel MI, Beuscher VD, Lucking H, Hoelter P, Kuramatsu JB, Huttner HB: Neutrophil-to-lymphocyte ratio is an independent predictor for in-hospital mortality in spontaneous intracerebral hemorrhage. Cerebrovasc Dis 2017;44:26-34.
Zahuranec DB, Brown DL, Lisabeth LD, Gonzales NR, Longwell PJ, Smith MA, Garcia NM, Morgenstern LB: Early care limitations independently predict mortality after intracerebral hemorrhage. Neurology 2007;68:1651-1657.
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