J Neurointensive Care.  2020 Apr;3(1):12-19. 10.32587/jnic.2020.00227.

Role of Cancer Emboli as a Metastatic Core on the Growth of Brain Metastasis in Patients with Non-Small Cell Lung Cancer

• Kim J
• Jung G
• Kim HG
• Kim JY
• Yang GY
• Kim YZ

• KMID: 2555033
• DOI: http://doi.org/10.32587/jnic.2020.00227

Abstract

Objective
Brain metastasis (BM) was a common complication of patient with non-small cell lung cancer (NSCLC) and associated with a poor prognosis. The study was to evaluate the effect of cerebral infarction (CI) which was originated from cancer emboli on the risk of BM in NSCLC for preventive therapy strategy.
Methods
Three hundred seven patients with newly diagnosed NSCLC in our institute from July 2013 to July 2018 were retrospectively analyzed. The diagnostic criteria of CI refereed to Updated Criteria for Population-Based Stroke and Transient Ischemic Attack Incidence Studies for the 21st Century. Depending on magnetic resonance imaging (MRI), the patients were divided into the BM group and control group (without BM). Then, the prevalence of CI and baseline clinicopathological parameters were evaluated and compared between the two groups.
Results
Of the 307 patients, 204 patients (66.4%) had CI and 52 patients (16.9%) had BM. Especially, the prevalence of CI in the NSCLC patients with BM was 84.6%, which was significantly higher than that of 62.7% in the NSCLC patients without BM (p = 0.002). Following univariate logistic regression analysis and the multivariate model, the results demonstrated that CI was a significant independent risk factor for BM in NSCLC (odds rate, 3.303; 95% confidence interval, 1.437-7.593; p = 0.005). What’s more, CI contributed to a worse prognosis in NSCLC patients with BM. Dynamical trace confirmed CI could promote BM in NSCLC patient.
Conclusions
CI could be associated with a metastatic tropism to the brain and then with an increased risk of BM in NSCLC patient. Therefore, targeted intervention of the metastatic core of CI could offer promising approach for the prevention, prognostic evaluation, and therapy of BM in NSCLC patients for better clinical outcome.

Keyword

Cancer emboli; Metastatic core; Non-small cell lung cancer; Brain metastasis; Cerebral infarction