Division of Neurosurgery, Shizuoka Cancer Center Hospital, Nagaizumi, Shizuoka, 411-8777, Japan.
Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, Shizuoka, 411-8777, Japan.
J Neurooncol. 2017 Nov;135(2):299-306. doi: 10.1007/s11060-017-2574-x. Epub 2017 Jul 27.
The embolization of cancer cells to cerebral vessels occurs early in the multi-step metastatic process. We aimed to determine whether the presence of leukoaraiosis (LA) before treatment would predict the development of brain metastases (BM) in patients with lung cancer. Between January 2014 and June 2015, 1007 patients underwent initial (i.e., prior to any chemotherapy) or routine magnetic resonance (MR) imaging of the brain and exhibited no evidence of BM. Of these, 189 underwent repeat MR imaging; 34 of 189 patients (18%) developed new BM, whereas 155 patients did not. LA was retrospectively evaluated according to Fazekas scale on the initial screening MR images of these 189 patients. The frequency of grade 0 periventricular hyperintensity (PVH) was greater among patients with BM, compared to those without BM (p = 0.001). In a multivariate analysis, patients with adenocarcinoma (95% confidence interval [CI] 1.8-171.8) and small cell carcinoma (95% CI 1.4-172.4) respectively developed BM at 9.3- and 8.8-fold higher rates than those with squamous cell carcinoma. Patients with grade 0 PVH developed BM at a rate 3.5-, 8.6-, and 3.6-fold higher rates than those with grade 1 (95% CI 1.4-9.0), 2 (95% CI 2.4-41.9), and 3 (95% CI 1.02-15.0), respectively. Lung cancer patients with grade 0 PVH on initial MR images have a high subsequent incidence of BM. PVH is a useful method for evaluating risk of BM.
癌细胞向脑血管的栓塞发生在多步骤转移过程的早期。我们旨在确定治疗前是否存在脑白质疏松症（LA）是否会预测肺癌患者脑转移（BM）的发展。在 2014 年 1 月至 2015 年 6 月期间，1007 名患者接受了初始（即在任何化疗之前）或常规磁共振（MR）脑部成像，并且没有 BM 的证据。其中，189 名患者接受了重复的 MR 成像；189 名患者中有 34 名（18％）发生了新的 BM，而 155 名患者没有。在这 189 名患者的初始筛选 MR 图像上，根据 Fazekas 量表回顾性评估了 LA。与没有 BM 的患者相比，有 BM 的患者的脑室周围高信号（PVH）分级 0 的频率更高（p = 0.001）。在多变量分析中，腺癌（95％置信区间[CI] 1.8-171.8）和小细胞癌（95％CI 1.4-172.4）患者分别比鳞癌患者高 9.3-和 8.8 倍发生 BM。PVH 分级 0 的患者发生 BM 的比率分别比 PVH 分级 1（95％CI 1.4-9.0）、2（95％CI 2.4-41.9）和 3（95％CI 1.02-15.0）高 3.5-、8.6-和 3.6 倍。初始 MR 图像上有 PVH 分级 0 的肺癌患者随后 BM 的发生率较高。PVH 是评估 BM 风险的有用方法。
