Abstract TP285: Risk of Stroke in Patients with Head and Neck Cancer: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Introduction: Previous studies have observed an increased risk of stroke in head and neck cancer (HNC) survivors. However, whether this risk is amplified with exposure to various treatment modalities including radiotherapy is less certain, as are any potential mechanisms by which this increase in risk is mediated. This study aims to investigate the risk of stroke in patients with HNC and whether cancer type and treatment modalities have varying effects. Methods: This PRISMA-adherent systematic review involved a systematic search of PubMed, SCOPUS and Embase for studies reporting stroke incidence in patients with HNC and without prior strokes since inception to April 25,2024. The study protocol was registered prospectively on PROSPERO. The hazard ratios extracted from the studies were pooled for meta-analyses. Random effects meta-analyses and meta-regressions were used for primary analysis. Subgroup analyses and meta-regression were performed to determine if key categorical and hierarchical variables influenced the results. Risk of bias was performed using the Newcastle Ottawa Scale. Results: 22 studies [EL1] with 5,093,445 patients were included. The meta-analyses of nine studies showed that the risk of stroke was increased in patients with HNC compared to healthy controls (HR=1.45; 95%CI: 1.27-1.65, I2: 20%). Subgroup analyses demonstrated that the risk of stroke was significantly increased in HNC patients treated with radiotherapy alone compared to those treated with surgery alone (HR=1.66; 95%CI: 1.35-2.03, I2: 0%). Subgroup analyses also revealed an increased risk of stroke in HNC patients who had undergone any radiotherapy compared to HNC patients who had not undergone radiotherapy in the past (HR=1.47; 95%CI: 1.29-1.68, I2: 60%). Additionally, HNC patients who had undergone definitive chemoradiotherapy had increased risk of stroke compared to HNC patients who had undergone definitive surgery with or without adjuvant chemoradiotherapy (HR=1.28; 95%CI: 1.09-1.49, I2: 86%). Conclusion: We report an increased risk of stroke in HNC patients, which is consistently raised when compared with the general population. This risk is more significant in patients who had undergone radiotherapy. Future research should aim to understand the pathogenesis of stroke in HNC patients and the effect of different treatment modalities on stroke risk to develop effective preventive strategies, thereby guiding the management for patients with HNC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.037 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.032 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".