Negative impact of leukoaraiosis on the incidence of brain metastases in patients with lung cancer

Tateaki Naito,Nakamasa Hayashi,Fumiharu Ohka,Koichi Mitsuya,Yoko Nakasu,Toshiaki Takahashi

doi:10.1007/s11060-017-2574-x

Tateaki Naito, Nakamasa Hayashi + Show 4 more

Open Access

https://doi.org/10.1007/s11060-017-2574-x

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Abstract

The embolization of cancer cells to cerebral vessels occurs early in the multi-step metastatic process. We aimed to determine whether the presence of leukoaraiosis (LA) before treatment would predict the development of brain metastases (BM) in patients with lung cancer. Between January 2014 and June 2015, 1007 patients underwent initial (i.e., prior to any chemotherapy) or routine magnetic resonance (MR) imaging of the brain and exhibited no evidence of BM. Of these, 189 underwent repeat MR imaging; 34 of 189 patients (18%) developed new BM, whereas 155 patients did not. LA was retrospectively evaluated according to Fazekas scale on the initial screening MR images of these 189 patients. The frequency of grade 0 periventricular hyperintensity (PVH) was greater among patients with BM, compared to those without BM (p = 0.001). In a multivariate analysis, patients with adenocarcinoma (95% confidence interval [CI] 1.8–171.8) and small cell carcinoma (95% CI 1.4–172.4) respectively developed BM at 9.3- and 8.8-fold higher rates than those with squamous cell carcinoma. Patients with grade 0 PVH developed BM at a rate 3.5-, 8.6-, and 3.6-fold higher rates than those with grade 1 (95% CI 1.4–9.0), 2 (95% CI 2.4–41.9), and 3 (95% CI 1.02–15.0), respectively. Lung cancer patients with grade 0 PVH on initial MR images have a high subsequent incidence of BM. PVH is a useful method for evaluating risk of BM.

Highlights

Overall, 10–15% of patients with lung cancer have brain metastases (BM) at diagnosis, and an additional 20–25% will develop BM during the course of their illness [1]
periventricular hyperintensity (PVH) is a useful method for evaluating risk of BM
The results of our present study demonstrate that lung cancer patients without LA on initial magnetic resonance (MR) images have a higher likelihood of BM development, compared to those with LA

Summary

Introduction

10–15% of patients with lung cancer have brain metastases (BM) at diagnosis, and an additional 20–25% will develop BM during the course of their illness [1]. The multi-step metastatic process involves several biological mechanisms, including embolization, survival in circulation, endothelial invasion, angiogenesis, extravasation, proliferation within the brain parenchyma, and resistance to glial immune surveillance [2]. Leukoaraiosis (LA) is an age-related type of cerebral white matter degenerations in the centrum semiovale, and is characterized by hyperintensity on T2-weighted magnetic resonance (MR) images [3, 4]. Moody et al demonstrated significantly lower afferent microvascular density in LA lesions within deep white matter, compared to the corresponding deep white matter in a healthy subject, indicating that LA is a generalized cerebrovascular disease process [5]. Most pathogenetic schemes attribute LA to an insufficient blood supply to the cerebral deep white matter. LA findings on MR images have been reported to associate with high risks of stroke, dementia, and depression [6, 7]

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