Anai Moriyasu, Saruwatari Koichi, Ikeda Tokunori, Oda Seitaro, Tajima Yuka, Jodai Takayuki, Sakata Shinya, Iyama Shinji, Tomita Yusuke, Saeki Sho, Ichiyasu Hidenori, Sakagami Takuro
Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto, 860-8556, Japan.
Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1, Ikeda Nishi-ku, Kumamoto, 860-0082, Japan.
Int J Clin Oncol. 2022 May;27(5):863-870. doi: 10.1007/s10147-022-02132-w. Epub 2022 Feb 22.
Lung cancer patients have a high risk of cerebral infarction, but the clinical significance of cerebral infarction in advanced non-small cell lung cancer (NSCLC) remains unclear. This study aimed to comprehensively investigate the incidence, prognostic impact, and risk factors of cerebral infarction in patients with NSCLC.
We retrospectively examined 710 consecutive patients with advanced or post-operative recurrent NSCLC treated between January 2010 and July 2020 at Kumamoto University Hospital. Cerebral infarction was diagnosed according to the detection of high-intensity lesions on diffusion-weighted magnetic resonance imaging regardless of the presence of neurological symptoms during the entire course from 3 months before NSCLC diagnosis. The prognostic impact and risk factors of cerebral infarction were evaluated based on propensity score matching (PSM) and multivariate logistic regression analysis.
Cerebral infarction occurred in 36 patients (5%). Of them, 21 (58%) and 15 (42%) patients developed asymptomatic and symptomatic cerebral infarction, respectively. PSM analysis for survival showed that cerebral infarction was an independent prognostic factor (hazards ratio: 2.45, 95% confidence interval (CI): 1.24-4.85, P = 0.010). On multivariate logistic regression analysis, D-dimer (odds ratio [OR]: 1.09, 95% CI 1.05-1.14, P < 0.001) and C-reactive protein (OR: 1.10, 95% CI 1.01-1.19, P = 0.023) levels were independent risk factors.
Cerebral infarction occurred in 5% of NSCLC patients, and asymptomatic cerebral infarction was more frequent. Cerebral infarction was a negative prognostic factor and was associated with hyper-coagulation and inflammation. The high frequency of asymptomatic cerebral infarction and its risk in NSCLC patients with these conditions should be recognized.
肺癌患者发生脑梗死的风险较高，但晚期非小细胞肺癌（NSCLC）中脑梗死的临床意义仍不明确。本研究旨在全面调查NSCLC患者脑梗死的发生率、预后影响及危险因素。
我们回顾性研究了2010年1月至2020年7月在熊本大学医院接受治疗的710例连续的晚期或术后复发NSCLC患者。根据扩散加权磁共振成像上高强度病变的检测结果诊断脑梗死，无论在NSCLC诊断前3个月的整个病程中是否存在神经症状。基于倾向评分匹配（PSM）和多因素逻辑回归分析评估脑梗死的预后影响和危险因素。
36例患者（5%）发生脑梗死。其中，分别有21例（58%）和15例（42%）患者发生无症状性和有症状性脑梗死。生存的PSM分析显示，脑梗死是一个独立的预后因素（风险比：2.45，95%置信区间（CI）：1.24 - 4.85，P = 0.010）。多因素逻辑回归分析显示，D - 二聚体（比值比[OR]：1.09，95% CI 1.05 - 1.14，P < 0.001）和C反应蛋白（OR：1.10，95% CI 1.01 - 1.19，P = 0.023）水平是独立危险因素。
5%的NSCLC患者发生脑梗死，无症状性脑梗死更为常见。脑梗死是一个不良预后因素，与高凝状态和炎症相关。应认识到NSCLC患者中无症状性脑梗死的高发生率及其风险。
