Malignant Solid Tumor-related Spontaneous Intracerebral Hemorrhage: a Propensity Score Matching Study

Overview

Journal PeerJ

Specialties Biology
Environmental Health
General Medicine

Date 2024 Dec 27

PMID 39726750

Authors

Shuolin Liang

LiuYu Liu

Bin Qin

Shengri Chen

Zhijian Liang

Affiliations

Soon will be listed here.

Abstract

Background: Spontaneous intracerebral hemorrhage (sICH) is a severe event with high mortality. Recently, evidence has emerged suggesting that malignant solid tumors may increase the risk of sICH through unique cancer-related factors. However, the specific risk factors and clinical characteristics of sICH in patients with malignant solid tumor remain poorly understood.

Objective: This study aimed to investigate the clinical characteristics of and identify the risk factors associated with sICH in individuals with malignant solid tumors.

Methods: This retrospective study was carried out in patients with active malignant solid tumors and sICH at the First Affiliated Hospital of Guangxi Medical University between January 2010 and December 2020. Patients were separated into control and malignant solid tumor-related spontaneous intracerebral hemorrhage (MST-sICH) groups. The control group consisted of patients presenting with malignant solid tumors alone who were matched to the MST-sICH group using a 1:1 propensity score matching (PSM) approach. Patient clinical data, laboratory findings, and imaging results were collected. Univariate analysis was carried out to determine the risk factors associated with MST-sICH. In addition, a receiver operator characteristic analysis was performed to identify potential predictors for poor prognosis.

Results: Decreased hemoglobin (HGB) levels, together with increased lymphocyte counts (LYCs), and an increased neutrophil-to-lymphocyte ratio (NLR) were found in the MST-sICH group compared to the control group. The results of the multivariate logistic regression analysis indicated a HGB levels (OR: 0.959, 95% CI [0.928-0.992]), an increased in LYCs (OR: 0.095, 95% CI [0.023-0.392]). Furthermore, there was an increased in NLR levels (OR: 2.137, 95% CI [1.427-3.200]). In the receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) with HGB, LYCs, and NLR as joint predictors was 0.955 (95% CI [0.901-1.000]), with a sensitivity of 100%, a specificity of 82.6%, and a Youden Index of 0.826.

Conclusion: Decreased HGB levels, elevated LYCs, and a higher NLR were identified as independent risk factors for sICH in patients with active solid malignancies. These markers could assist clinicians in stratifying high-risk patients, facilitating closer monitoring and informing targeted preventive strategies to mitigate the incidence of sICH in this at-risk population.

References

Leca J, Lemonnier F, Meydan C, Foox J, El Ghamrasni S, Mboumba D . IDH2 and TET2 mutations synergize to modulate T Follicular Helper cell functional interaction with the AITL microenvironment. Cancer Cell. 2023; 41(2):323-339.e10. DOI: 10.1016/j.ccell.2023.01.003. View

Navi B, Reichman J, Berlin D, Reiner A, Panageas K, Segal A . Intracerebral and subarachnoid hemorrhage in patients with cancer. Neurology. 2010; 74(6):494-501. PMC: 2830918. DOI: 10.1212/WNL.0b013e3181cef837. View

Iyengar N, Gucalp A, Dannenberg A, Hudis C . Obesity and Cancer Mechanisms: Tumor Microenvironment and Inflammation. J Clin Oncol. 2016; 34(35):4270-4276. PMC: 5562428. DOI: 10.1200/JCO.2016.67.4283. View

Erturk M, Cakmak H, Surgit O, Celik O, Unal Aksu H, Akgul O . Predictive value of elevated neutrophil to lymphocyte ratio for long-term cardiovascular mortality in peripheral arterial occlusive disease. J Cardiol. 2014; 64(5):371-6. DOI: 10.1016/j.jjcc.2014.02.019. View

Tas F, Eralp Y, Basaran M, Sakar B, Alici S, Argon A . Anemia in oncology practice: relation to diseases and their therapies. Am J Clin Oncol. 2002; 25(4):371-9. DOI: 10.1097/00000421-200208000-00011. View

Rogers L . Cerebrovascular complications in patients with cancer. Semin Neurol. 2005; 24(4):453-60. DOI: 10.1055/s-2004-861539. View

Zoller B, Ji J, Sundquist J, Sundquist K . Risk of haemorrhagic and ischaemic stroke in patients with cancer: a nationwide follow-up study from Sweden. Eur J Cancer. 2012; 48(12):1875-83. DOI: 10.1016/j.ejca.2012.01.005. View

Zhao Y, Xie H, Pan C, Yao Y, Gong Z, Li Y . Clinical Characteristics and Risk Factors of Cerebral Hemorrhage in Patients with Occult Malignant Tumors. Neuropsychiatr Dis Treat. 2021; 17:2729-2738. PMC: 8382450. DOI: 10.2147/NDT.S321571. View

Ardestani S, Inserra P, Solkoff D, Watson R . The role of cytokines and chemokines on tumor progression: A review. Cancer Detect Prev. 1999; 23(3):215-25. DOI: 10.1046/j.1525-1500.1999.99021.x. View

10.

Chen C, Tai C, Cheng A, Wu H, Tsay W, Liu J . Intracranial hemorrhage in adult patients with hematological malignancies. BMC Med. 2012; 10:97. PMC: 3482556. DOI: 10.1186/1741-7015-10-97. View

11.

Steensma D . Is anemia of cancer different from chemotherapy-induced anemia?. J Clin Oncol. 2008; 26(7):1022-4. DOI: 10.1200/JCO.2007.15.3874. View

12.

van Asch C, Luitse M, Rinkel G, van der Tweel I, Algra A, Klijn C . Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010; 9(2):167-76. DOI: 10.1016/S1474-4422(09)70340-0. View

13.

Gliozzi M, Scicchitano M, Bosco F, Musolino V, Carresi C, Scarano F . Modulation of Nitric Oxide Synthases by Oxidized LDLs: Role in Vascular Inflammation and Atherosclerosis Development. Int J Mol Sci. 2019; 20(13). PMC: 6651385. DOI: 10.3390/ijms20133294. View

14.

DeNardo D, Ruffell B . Macrophages as regulators of tumour immunity and immunotherapy. Nat Rev Immunol. 2019; 19(6):369-382. PMC: 7339861. DOI: 10.1038/s41577-019-0127-6. View

15.

Lopez A, Cacoub P, Macdougall I, Peyrin-Biroulet L . Iron deficiency anaemia. Lancet. 2015; 387(10021):907-16. DOI: 10.1016/S0140-6736(15)60865-0. View

16.

Moore C, Tymvios C, Emerson M . Functional regulation of vascular and platelet activity during thrombosis by nitric oxide and endothelial nitric oxide synthase. Thromb Haemost. 2010; 104(2):342-9. DOI: 10.1160/TH09-11-0764. View

17.

Markowitz S . Atherosclerosis, just another cancer?. J Clin Invest. 1997; 100(9):2143-5. PMC: 508407. DOI: 10.1172/JCI119749. View

18.

Jirasek A, Knief J, Deng M, Reddemann K, Thorns C . Evaluation of general and coronary atherosclerosis and malignant disease demonstrates inverse correlations for specific cancer types as well as cancer in general. Pathol Res Pract. 2016; 212(11):988-994. DOI: 10.1016/j.prp.2016.07.019. View

19.

Knight K, Wade S, Balducci L . Prevalence and outcomes of anemia in cancer: a systematic review of the literature. Am J Med. 2004; 116 Suppl 7A:11S-26S. DOI: 10.1016/j.amjmed.2003.12.008. View

20.

Adamson J . The anemia of inflammation/malignancy: mechanisms and management. Hematology Am Soc Hematol Educ Program. 2008; :159-65. DOI: 10.1182/asheducation-2008.1.159. View