Can vascular risk factors influence number and size of cerebral metastases? A 3D-MRI study in patients with different tumor entities

Vascular white matter lesions negatively correlate with brain metastases in malignant melanoma-Results from a retrospective comparative analysis

OBJECTIVES

Brain metastasis (BM) is a major complication of different cancers. There is increasing evidence for influence of vascular factors on BM in patients with non-small cell lung cancer (NSCLC). It is not known if the same is true for other tumors that might rely on different forms of vasculogenesis. The objective of this retrospective study was to evaluate a possible negative association of vascular white matter lesions and vascular risk factors (vasRF) with brain metastases in patients with melanoma.

PATIENTS AND METHODS

3D-brain magnetic resonance imaging (MRI) of 30 patients with BM from malignant melanoma and screening MRI of 31 BM negative patients were analysed. Number of metastases was calculated and T2 hyperintensive white matter lesions (WML) were classified according to Fazekas-Score (grade I-III) per patient and compared between BM+ and BM- patients.

RESULTS

Patients without BM showed more pronounced WML (median = WML 1, mean = 1.3; SD = 1.04,) than patients with BM (median = WML 0, mean = 0.6; SD = 0.8, p = 0.017). With respect to vascular risk factors, BM were more likely (p^x2 = 0.019) in patients without vasRF.

CONCLUSIONS

WML and possibly vasRF may reduce the risk of BM in different malignant tumors including melanoma. Presence of WML in patients with BM could potentially influence treatment choice regarding local or whole brain treatment after further multicentric prospective validation.

Cardiovascular disease and survival in non-small cell lung cancer: a multicenter prospective assessment

PURPOSE

Chronic inflammation contributes to cancer development via multiple mechanisms. We hypothesized that cardiovascular diseases (CVD) are also an independent risk factor for survival in non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

Prospective multicenter data from 345 consecutive NSCLC patients treated from January 2013 to January 2017 were assessed. Median follow-up for all patients was 13 months (range 3-60 months). There were 109 patients with baseline heart disease (HD 32%), 149 with arterial hypertension (43%), 85 with diabetes mellitus (25%), 129 with hyperlipidemia (37%) and 45 with venous thromboembolism events (VTE 13%). A total of 289 patients (84%) were treated with platinum-based chemotherapy (CT), 300 patients (87%) received thoracic radiation therapy (RT; median radiation dose: 60 Gy [range 12-70]); and 50 (15%) patients underwent surgery.

RESULTS

Our cohort consisted of 305 men (88%) and 40 (12%) women, with a median age of 67 years (range 31-88 years). Seventy percent had a Karnofsky performance status (KPS) ≥ 80. Multivariate analyses showed a lower OS and higher risk of distant metastasis in patients with advanced stages (p = 0.05 and p < 0.001, respectively) and HD (HR 1.43, p = 0.019; and HR 1.49, p = 0.025, respectively). Additionally, patients with VTE had lower local control (HR 1.84, p = 0.025), disease-free survival (HR 1.64, p = 0.020) and distant metastasis-free survival (HR 1.73, p = 0.025).

CONCLUSIONS

HD and VTE are associated with a higher risk of mortality and distant metastasis in NSCLC patients. Chronic inflammation associated with CVDs could be an additional pathophysiologic factor in the development of distant metastasis.