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


RESULTS
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
These findings suggest that vascular changes in the brain are protective against the development of brain metastases in lung cancer patients.
Respiratory Institute, The Cleveland Clinic, Cleveland, Ohio, United States of America. mazzonp@ccf.org
Peter J
PJ
Mazzone
Nicola
N
Marchi
Vince
V
Fazio
J Michael
JM
Taylor
Thomas
T
Masaryk
Luke
L
Bury
Tarek
T
Mekhail
Damir
D
Janigro
D000368:Aged; D001706:Biopsy; D002545:Brain Ischemia / Q000150:complications / Q000473:pathology*; D001932:Brain Neoplasms / Q000556:secondary*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome