title: Hypertension and risk of brain metastasis from small cell lung cancer: a retrospective follow-up study.
abstract: BACKGROUND
  Although metastatic brain cancer is one of the most common forms of cancer, little is known about the factors associated with its development. We examined the hypothesis that hypertension may increase the risk for brain metastasis (BM) in patients with primary small cell lung cancer (SCLC).
  
  
  METHODS
  A retrospective review of medical charts of patients diagnosed with SCLC between June, 1986 and June, 2003 at MeritCare in Fargo, ND, USA, was done to determine which of these patients subsequently developed brain metastases. The effects of hypertension, age, gender, body mass index and the site of SCLC on the risk of developing BM were examined using both univariate and multivariable Cox proportional-hazards regression models. Two-way interactions between hypertension and other covariates were also included in the analyses.
  
  
  RESULTS
  Two hundred and thirty-two patients were identified with SCLC and 185 patients were eligible for this study. Eighty-five (45.9%) patients developed BM. Over 54% of SCLC occurred in the right lobe and more than 70% of the patients with BM had them in multiple locations. The risk of BM is significantly higher in younger patients (p-value < 0.03). Univariate analysis showed a hazard ratio (HR) for hypertension of 1.01 (95% Confidence Interval (CI) 0.6-1.6) for BM from SCLC. The multivariable Cox model showed an adjusted HR for hypertension of 1.06 (95%CI 0.7-1.6) for BM from SCLC CONCLUSION: As has been consistently observed for other lung cancers, SCLC is more common in the right lung. The higher incidence of BM in younger patients suggests that more aggressive therapy is needed in these patients. Hypertension does not appear to increase the risk of BM from SCLC.
authors.affiliation: Department of Medicine, University of North Dakota School of Medicine, Fargo, ND 58102, USA. asahmoun@medicine.nodak.edu
authors.forename: Abe E
authors.initials: AE
authors.lastname: Sahmoun
authors.forename: L Douglas
authors.initials: LD
authors.lastname: Case
authors.forename: Sudhir
authors.initials: S
authors.lastname: Chavour
authors.forename: Sohail
authors.initials: S
authors.lastname: Kareem
authors.forename: Gary G
authors.initials: GG
authors.lastname: Schwartz
mesh_terms: D000367:Age Factors; D000368:Aged; D001932:Brain Neoplasms / Q000556:secondary*; D018288:Carcinoma, Small Cell / Q000150:complications / Q000473:pathology / Q000556:secondary*; D002560:Cerebrovascular Circulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D008175:Lung Neoplasms / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013687:Telencephalon / Q000098:blood supply