title: Cerebral infarction in advanced non-small cell lung cancer: a case control study.
abstract: BACKGROUND
  Advanced non-small cell lung cancer (NSCLC) patients often develop thromboembolic events, including cerebral infarction (CI). However, the relationship between advanced NSCLC and CI has not been thoroughly investigated. We examined the association between advanced NSCLC and CI and risk factors for CI in advanced or post-operative recurrent NSCLC patients.
  
  
  METHODS
  We retrospectively investigated 515 patients diagnosed with advanced or post-operative recurrent NSCLC at Juntendo University Hospital between April 2009 and March 2014.
  
  
  RESULTS
  Among the 515 patients evaluated, 15 patients (2.9%) developed CI after diagnosis of advanced or post-operative recurrent NSCLC. Univariate and multivariate analyses were conducted, and brain metastasis was the only significant independent risk factor for CI (odds ratio 5.24, 95% confidence interval 1.72-16.10, p = 0.004). The incidence was 6.3% in these patients. The median survival time was 36 days, and 1-year survival rate was 6.7% after development of CI. Overall survival from diagnosis of advanced NSCLC or post-operative recurrence was significantly shorter in patients with CI than in patients without CI (223 days versus 895 days; HR, 3.46; 95% confidence interval, 2.04-6.02; p = 0.001).
  
  
  CONCLUSIONS
  The incidence of CI is high in advanced or post-operative recurrent NSCLC, and is especially higher in patients with brain metastasis than in those without brain metastasis. Moreover, CI may affect patient's prognosis. Careful monitoring for the development of CI in patients with advanced or post-operative recurrent NSCLC is needed, especially for patients with brain metastasis.
authors.affiliation: Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan. mtkatou@juntendo.ac.jp.
authors.forename: Motoyasu
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan. tshukuya@juntendo.ac.jp.
authors.forename: Takehito
authors.initials: T
authors.lastname: Shukuya
authors.affiliation: Clinical Trial Coordination Office, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Mori
authors.affiliation: Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Kanemaru
authors.affiliation: Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Honma
authors.affiliation: Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Nanjo
authors.affiliation: Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Muraki
authors.affiliation: Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
authors.forename: Rina
authors.initials: R
authors.lastname: Shibayama
authors.affiliation: Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Koyama
authors.affiliation: Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Shimada
authors.affiliation: Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
authors.forename: Fumiyuki
authors.initials: F
authors.lastname: Takahashi
authors.affiliation: Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000473:pathology* / Q000556:secondary; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000473:pathology*; D016022:Case-Control Studies; D002544:Cerebral Infarction / Q000150:complications / Q000473:pathology*; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011184:Postoperative Period; D011379:Prognosis; D012307:Risk Factors
keywords: Brain metastasis; Cerebral infarction; Non-small cell lung cancer; Thrombosis; Trousseau syndrome