Background: Brain metastases (BM) cause relevant morbidity and mortality in cancer patients. The presence of cerebrovascular diseases can alter the tumor microenvironment, cellular proliferation and treatment resistance. However, it is largely unknown if the presence of distinct cerebrovascular risk factors may alter the prognosis of patients with BM. Methods: Patients admitted for the radiotherapy of BM at a large tertiary cancer center were included. Patient and survival data, including cerebrovascular risk factors (diabetes mellitus (DM), smoking, arterial hypertension, peripheral arterial occlusive disease, hypercholesterolemia and smoking) were recorded. Results: 203 patients were included. Patients with DM (n= 39) had significantly shorter overall survival (OS) (HR 1.75 (1.20–2.56),p= 0.003, log-rank). Other vascular comorbidities were not associated with differences in OS. DM remained prognostically significant in the multivariate Cox regression including established prognostic factors (HR 1.92 (1.20–3.06),p= 0.006). Furthermore, subgroup analyses revealed a prognostic role of DM in patients with non-small cell lung cancer, both in univariate (HR 1.68 (0.97–2.93),p= 0.066) and multivariate analysis (HR 2.73 (1.33–5.63),p= 0.006), and a trend in melanoma patients. Conclusion: DM is associated with reduced survival in patients with BM. Further research is necessary to better understand the molecular mechanisms and therapeutic implications of this important interaction.
背景：脑转移瘤（BM）是导致癌症患者发病和死亡的重要原因。脑血管疾病的存在可能改变肿瘤微环境、细胞增殖及治疗抵抗性。然而，不同脑血管危险因素是否会影响脑转移瘤患者的预后，目前尚不明确。方法：本研究纳入某大型三级癌症中心收治的接受脑转移瘤放疗的患者。记录患者资料、生存数据及脑血管危险因素（糖尿病、吸烟、动脉高血压、外周动脉闭塞性疾病、高胆固醇血症）。结果：共纳入203例患者。合并糖尿病患者（n=39）的总生存期显著缩短（风险比1.75（1.20–2.56），p=0.003，对数秩检验）。其他血管合并症与总生存期差异无显著关联。在多变量Cox回归分析中，纳入既定预后因素后，糖尿病仍具有显著预后价值（风险比1.92（1.20–3.06），p=0.006）。亚组分析进一步显示，在非小细胞肺癌患者中，糖尿病在单变量（风险比1.68（0.97–2.93），p=0.066）和多变量分析（风险比2.73（1.33–5.63），p=0.006）中均具有预后意义，在黑色素瘤患者中也观察到类似趋势。结论：糖尿病与脑转移瘤患者生存期缩短相关。需进一步研究以深入理解这一重要相互作用的分子机制及治疗意义。
肿瘤(癌症)患者之家