Clinical and Imaging Features and Risk Factors of Breast Cancer-Related Cerebral Infarction

doi:10.3969/j.issn.1673-5765.2021.02.007

Abstract

Abstract:

Objective To investigate the clinical and imaging characteristics and risk factors of breast cancerrelated cerebral infarction. Methods In this retrospective case-control study, 30 patients with breast cancer-related cerebral infarction successively admitted to the First Affiliated Hospital of Guangxi Medical University between January 2007 and December 2017 were selected as the observation group, and 30 age- , gender- matched patients with only cerebral infarction and 30 age-, gender-, and tumor typematched patients with only breast cancer were selected as the controls. Compared to the two control groups, the clinical and imaging features of cerebral infarction, and the features of breast cancer in cerebral infarction patients with breast cancer were analyzed. Multivariate logistic regression analysis was used to determine the risk factors for cerebral infarction in breast cancer patients. Results Compared with only cerebral infarction group, infarcts of most patients in the observation group were multiple small lesions located in multi-artery territory, and the observation group had higher mortality at discharge (13.33% vs 0, P =0.048). The advanced cancer (stage Ⅲ and Ⅳ for 53.33%) and distant metastasis (70.00% vs 43.33%, P =0.037) were more common in observation group than in only breast cancer group. Additionally, elevated levels of plasma fibrinogen (OR 2.341, 95%CI 1.013-5.411, P =0.047) and serum cancer antigen (CA) 153 (OR 1.059, 95%CI 1.006-1.115, P =0.027) and hormonotherapy (OR 4.557, 95%CI 1.009-20.579, P =0.049) were independent risk factors for cerebral infarction in breast cancer. Conclusions The features of cerebral infarcts in breast cancer patients were multiple small infarcts involving multi-artery territory, the advanced cancer and distant metastases were more common in these patients, which tended to a poor prognosis. The elevated level of plasma fibrinogen and serum CA153, and the use of hormones may be independent risk factors for cerebral infarction in patients with breast cancer.

Key words: Breast cancer; Ischemic stroke; Imaging feature; Risk factor

摘要：

目的探讨乳腺癌相关脑梗死的临床特点和危险因素。方法本研究为回顾性病例对照分析，纳入2007年1月-2017年12月广西医科大学第一附属医院连续收治的30例乳腺癌相关脑梗死患者，按性别、年龄、肿瘤类型相匹配等原则分别选择30例单纯脑梗死和30例单纯乳腺癌患者作为对照。分析相比两对照组，乳腺癌相关脑梗死组的脑梗死临床及影像学特征、乳腺癌特征，应用多因素logistic回归分析乳腺癌患者发生脑梗死的危险因素。结果与单纯脑梗死组相比，乳腺癌相关脑梗死组多数患者的梗死灶为位于多支动脉供血区的多发小病灶，出院时死亡率增高（13.33% vs 0，P =0.048）；与单纯乳腺癌组相比，乳腺癌相关脑梗死组多为晚期癌症（53.33%为Ⅲ、Ⅳ期），且发生远处转移者多见（70.00% vs 43.33%，P =0.037）。多因素 logistic回归分析显示，血浆纤维蛋白原（OR 2.341，95%CI 1.013～5.411，P =0.047）和血清癌抗原153 （OR 1.059，95%CI 1.006～1.115，P =0.027）水平升高，以及服用激素（OR 4.557，95%CI 1.009～20.579， P =0.049）是乳腺癌患者发生脑梗死的独立危险因素。结论乳腺癌相关脑梗死患者梗死灶特点多为累及多支动脉供血区的多发小病灶，多为晚期癌症，常发生远处转移，预后不良。而血浆纤维蛋白原、血清癌抗原153水平升高，以及服用激素是乳腺癌患者发生脑梗死的独立危险因素。

关键词: 乳腺癌; 脑梗死; 临床特点; 危险因素

CHENG Xue-Min,QIN Qi-Xiong, LU Li-Zhi, QUAN Xue-Mei, CHEN Ya, WEI Yun-Fei, LIANG Zhi-Jian. Clinical and Imaging Features and Risk Factors of Breast Cancer-Related Cerebral Infarction[J]. Chinese Journal of Stroke, 2021, 16(02): 147-152.

程学敏，覃奇雄，卢丽至，全雪梅，陈娅，韦云飞，梁志坚. 乳腺癌相关脑梗死的临床和影像学特征及危险因素分析[J]. 中国卒中杂志, 2021, 16(02): 147-152.

References

[1] CHEN W，ZHENG R，BAADE P D，et al. Cancer

statistics in China，2015[J]. CA Cancer J Clin，2016，

66（2）：115-132.

[2] CHEN W Q，SUN K X，ZHENG R S，et al. Cancer

incidence and mortality in China，2014[J]. Chin J

Cancer Res，2018，30（1）：1-12.

[3] KONO T，OHTSUKI T，HOSOMI N，et al. Cancerassociated

ischemic stroke is associated with

elevated D-dimer and fibrin degradation product

levels in acute ischemic stroke with advanced

cancer[J]. Geriatr Gerontol Int，2012，12（3）：468-

474.

[4] ZOLLER B，JI J G，SUNDQUIST J，et al. Risk

of haemorrhagic and ischaemic stroke in patients

with cancer：a nationwide follow-up study from

Sweden[J]. Eur J Cancer，2012，48（12）：1875-1883.

[5] NAVI B B，SINGER S，MERKLER A E，et al.

Cryptogenic subtype predicts reduced survival

among cancer patients with ischemic stroke[J].

Stroke，2014，45（8）：2292-2297.

[6] KNEIHSL M，ENZINGER C，WUNSCH G，et al.

Poor short-term outcome in patients with ischaemic

stroke and active cancer[J]. J Neurol，2016，263（1）：

150-156.

[7] WANG W Z，JIANG B，SUN H X，et al. Prevalence，

incidence，and mortality of stroke in China：results

from a nationwide population-based survey of

480 687 adults[J]. Circulation 2017，135（8）：759-771.

[8] ZHOU M，WANG H，ZENG X，et al. Mortality，

morbidity，and risk factors in China and its provinces，

1990–2017：a systematic analysis for the Global

Burden of Disease Study 2017[J]. Lancet，2019，394

（10204）：1145-1158.

[9] NAVI B B，REINER A S，KAMEL H，et al.

Association between incident cancer and subsequent

stroke[J]. Ann Neurol，2015，77（2）：291-300.

[10] LAI S W，LIN C L，LIAO K F. Tamoxifen use

correlates with increased risk of the first episode of

ischemic cerebrovascular disease in older women

with breast cancer：a case-control study in Taiwan[J/

OL]. Front Pharmacol，2017，8：742[2020-10-08].

https：//doi.org/10.3389/fphar.2017.00742.

[11] NAVI B B，REINER A S，KAMEL H，et al. Risk of

arterial thromboembolism in patients with cancer[J].

J Am Coll Cardiol，2017，70（8）：926-938.

[12] CUTTING S，WETTENGEL M，CONNERS J J，et

al. Three-month outcomes are poor in stroke patients

with cancer despite acute stroke treatment[J]. J

Stroke Cerebrovasc Dis，2017，26（4）：809-815.

[13] FINELLI P F，NOUH A. Three-territory DWI acute

infarcts：diagnostic value in cancer-associated

hypercoagulation stroke（Trousseau Syndrome）[J].

AJNR Am J Neuroradiol，2016，37（11）：2033-2036.

[14] SELVIK H A，BJERKREIM A T，THOMASSEN L，

et al. When to screen ischaemic stroke patients for

cancer[J]. Cerebrovasc Dis，2018，45（1/2）：42-47.

[15] PRUGGER C，LUC G，HAAS B，et al. Multiple

biomarkers for the prediction of ischemic stroke：the

PRIME study[J]. Arterioscler Thromb Vasc Biol，

2013，33（3）：659-666.

[16] KIM K，LEE J H. Risk factors and biomarkers of

ischemic stroke in cancer patients[J]. J Stroke，2014，

16（2）：91-96.

[17] SHAO B J，WAHRENBROCK M G，YAO L B，et

al. Carcinoma mucins trigger reciprocal activation

of platelets and neutrophils in a murine model of

Trousseau syndrome[J]. Blood，2011，118（15）：

4015-4023.

[18] AMICO L，CAPLAN L R，THOMAS C.

Cerebrovascular complications of mucinous

cancers[J]. Neurology，1989，39（4）：522-526.

[19] CHOI J W，MOON B I，LEE J W，et al. Use of

CA153 for screening breast cancer：an antibodylectin

sandwich assay for detecting glycosylation of

CA153 in sera[J]. Oncology reports，2018，40（1）：

145-154.

[20] LIGIBEL J A，JAMES O'MALLEY A，FISHER

M，et al. Risk of myocardial infarction，stroke，and

fracture in a cohort of community-based breast

cancer patients[J]. Breast Cancer Res Treat，2012，

131（2）：589-597.

[21] HSU C W，HUANG Y B，KUO C C，et al.

Evaluating the primary prevention of ischemic

stroke of oral antithrombotic therapy in head and

neck cancer patients with radiation Therapy[J/OL].

Biomed Res Int，2016，2016：6205158[2020-10-08].

https：//doi.org/10.1155/2016/6205158.

[22] NAVI B B，MARSHALL R S，BOBROW D，et

al. Enoxaparin vs aspirin in patients with cancer

and ischemic stroke：the TEACH pilot randomized

clinical trial[J]. JAMA Neurol，2018，75（3）：379-

381.

[23] NAM K W，KIM C K，KIM T J，et al.

Intravenous thrombolysis in acute ischemic

stroke with active cancer[J/OL]. Biomed Res Int，

2017，2017：4635829[2020-10-08]. https：//doi.

org/10.1155/2017/4635829.

[24] SALLUSTIO F，MASCOLO A P，MARRAMA F，

et al. Safety and efficacy of reperfusion therapies

for acute ischemic stroke patients with active

malignancy[J]. J Stroke Cerebrovasc Dis，2019，28

（8）：2287-2291.