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Small vessel ischemic disease of the brain and brain metastases in lung cancer patients.

Mazzone PJ, Marchi N, Fazio V, Taylor JM, Masaryk T, Bury L, Mekhail T, Janigro D - PLoS ONE (2009)

Bottom Line: The primary outcome measure was the portion of study subjects with and without SVID of the brain who had evidence of brain metastases at the time of initial staging of their lung cancer.109 patients (20.8%) had evidence of brain metastases at presentation and 345 (66.0%) had evidence of SVID. 13.9% of those with SVID and 34.3% of those without SVID presented with brain metastases (p<0.0001).In a model including age, diabetes mellitus, hypertension, hyperlipidemia, and tobacco use, SVID of the brain was found to be the only protective factor against the development of brain metastases, with an OR of 0.31 (0.20, 0.48; p<0.001).The grade of SVID was higher in those without brain metastases.

View Article: PubMed Central - PubMed

Affiliation: Respiratory Institute, The Cleveland Clinic, Cleveland, Ohio, United States of America. mazzonp@ccf.org

ABSTRACT

Background: Brain metastases occur commonly in patients with lung cancer. Small vessel ischemic disease is frequently found when imaging the brain to detect metastases. We aimed to determine if the presence of small vessel ischemic disease (SVID) of the brain is protective against the development of brain metastases in lung cancer patients.

Methodology/principal findings: A retrospective cohort of 523 patients with biopsy confirmed lung cancer who had received magnetic resonance imaging of the brain as part of their standard initial staging evaluation was reviewed. Information collected included demographics, comorbidities, details of the lung cancer, and the presence of SVID of the brain. A portion of the cohort had the degree of SVID graded. The primary outcome measure was the portion of study subjects with and without SVID of the brain who had evidence of brain metastases at the time of initial staging of their lung cancer.109 patients (20.8%) had evidence of brain metastases at presentation and 345 (66.0%) had evidence of SVID. 13.9% of those with SVID and 34.3% of those without SVID presented with brain metastases (p<0.0001). In a model including age, diabetes mellitus, hypertension, hyperlipidemia, and tobacco use, SVID of the brain was found to be the only protective factor against the development of brain metastases, with an OR of 0.31 (0.20, 0.48; p<0.001). The grade of SVID was higher in those without brain metastases.

Conclusions/significance: These findings suggest that vascular changes in the brain are protective against the development of brain metastases in lung cancer patients.

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Related in: MedlinePlus

Relationship between SVID severity and metastatic brain tumor:The data are presented as % (filled symbols) or as a ratio between SVID severity in the two subsets of patients.
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pone-0007242-g004: Relationship between SVID severity and metastatic brain tumor:The data are presented as % (filled symbols) or as a ratio between SVID severity in the two subsets of patients.

Mentions: We then focused to the anatomical location of metastases in SVID positive or negative patients (Figure 3B and Figure 4). Patients with SVID had, on average, fewer metastases as expected if a negative correlation exists between SVID and metastatic tumor. This was true for all the regions where metastases were measured. in the region where SVID are most common (cerebrum) there was a statistically significant difference in the number of metastases as predicted by a protective effect of SVID against tumor growth. We then measured the severity of SVID in relation to the presence of metastases. As shown in Figure 4, patients with metastatic tumors had a much lower SVID score.


Small vessel ischemic disease of the brain and brain metastases in lung cancer patients.

Mazzone PJ, Marchi N, Fazio V, Taylor JM, Masaryk T, Bury L, Mekhail T, Janigro D - PLoS ONE (2009)

Relationship between SVID severity and metastatic brain tumor:The data are presented as % (filled symbols) or as a ratio between SVID severity in the two subsets of patients.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2747277&req=5

pone-0007242-g004: Relationship between SVID severity and metastatic brain tumor:The data are presented as % (filled symbols) or as a ratio between SVID severity in the two subsets of patients.
Mentions: We then focused to the anatomical location of metastases in SVID positive or negative patients (Figure 3B and Figure 4). Patients with SVID had, on average, fewer metastases as expected if a negative correlation exists between SVID and metastatic tumor. This was true for all the regions where metastases were measured. in the region where SVID are most common (cerebrum) there was a statistically significant difference in the number of metastases as predicted by a protective effect of SVID against tumor growth. We then measured the severity of SVID in relation to the presence of metastases. As shown in Figure 4, patients with metastatic tumors had a much lower SVID score.

Bottom Line: The primary outcome measure was the portion of study subjects with and without SVID of the brain who had evidence of brain metastases at the time of initial staging of their lung cancer.109 patients (20.8%) had evidence of brain metastases at presentation and 345 (66.0%) had evidence of SVID. 13.9% of those with SVID and 34.3% of those without SVID presented with brain metastases (p<0.0001).In a model including age, diabetes mellitus, hypertension, hyperlipidemia, and tobacco use, SVID of the brain was found to be the only protective factor against the development of brain metastases, with an OR of 0.31 (0.20, 0.48; p<0.001).The grade of SVID was higher in those without brain metastases.

View Article: PubMed Central - PubMed

Affiliation: Respiratory Institute, The Cleveland Clinic, Cleveland, Ohio, United States of America. mazzonp@ccf.org

ABSTRACT

Background: Brain metastases occur commonly in patients with lung cancer. Small vessel ischemic disease is frequently found when imaging the brain to detect metastases. We aimed to determine if the presence of small vessel ischemic disease (SVID) of the brain is protective against the development of brain metastases in lung cancer patients.

Methodology/principal findings: A retrospective cohort of 523 patients with biopsy confirmed lung cancer who had received magnetic resonance imaging of the brain as part of their standard initial staging evaluation was reviewed. Information collected included demographics, comorbidities, details of the lung cancer, and the presence of SVID of the brain. A portion of the cohort had the degree of SVID graded. The primary outcome measure was the portion of study subjects with and without SVID of the brain who had evidence of brain metastases at the time of initial staging of their lung cancer.109 patients (20.8%) had evidence of brain metastases at presentation and 345 (66.0%) had evidence of SVID. 13.9% of those with SVID and 34.3% of those without SVID presented with brain metastases (p<0.0001). In a model including age, diabetes mellitus, hypertension, hyperlipidemia, and tobacco use, SVID of the brain was found to be the only protective factor against the development of brain metastases, with an OR of 0.31 (0.20, 0.48; p<0.001). The grade of SVID was higher in those without brain metastases.

Conclusions/significance: These findings suggest that vascular changes in the brain are protective against the development of brain metastases in lung cancer patients.

Show MeSH
Related in: MedlinePlus