RESUMO
PURPOSE: Lung cancer (LC) is the most common source of brain metastases (BM). Because of the difficulty in predicting LC patients who will develop BM, we aimed to identify the clinical and serologic markers that could predict the presence of BM in LC patients. METHODS: We analyzed a cohort of LC patients sent for neurooncological consultation for any neurologic symptom at a cancer center from June 2013 to July 2017. INCLUSION CRITERIA: histologically confirmed LC, age ≥ 18 years and complete clinical records. EXCLUSION CRITERIA: BM diagnosis before our consultation and absence of MRI. Oncologic history, clinical symptoms and comorbidities were analyzed. RESULTS: From 199 patients, most (70%) had > 1 neurological symptom. The most common was headache (n = 46, 21%), followed by seizures (17%), altered mental status (16%) and focal motor weakness (13%). BM was found in 74% of the patients during follow-up. Multivariate logistic regression analysis showed factors associated with a higher frequency of BM: age < 65 years [OR 3.15, 95% CI 1.3-7.5], headache (OR 3.8, 95% CI 1.2-11.8), seizures (OR 3.2, 95% CI 1.1-9.3) and CEA ≥ 15 ng/mL (OR 5.5, 95% CI 2.2-13.8). Focal sensory deficit was associated with a lower frequency of BM (OR 0.2, 95% CI 0.06-0.92). The presence of certain clinical neurologic symptoms, together with CEA level, was associated with a higher risk of BM in LC patients. CONCLUSION: The clinical manifestations of patients with LC should not be overlooked because some may have a substantial correlation with BM.
Assuntos
Neoplasias Encefálicas/secundário , Antígeno Carcinoembrionário/sangue , Carcinoma Pulmonar de Células não Pequenas/secundário , Neoplasias Pulmonares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Neoplasias Encefálicas/sangue , Neoplasias Encefálicas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/sangue , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Comorbidade , Feminino , Cefaleia/etiologia , Humanos , Neoplasias Pulmonares/sangue , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Análise de Regressão , Convulsões/etiologia , Sensibilidade e Especificidade , Adulto JovemRESUMO
Resumen: ANTECEDENTES: el cáncer es una de las primeras causas de morbilidad y mortalidad en el mundo; la neoplasia endocrinológica más frecuente es el cáncer de tiroides. A pesar que la mayoría de los pacientes con cáncer de tiroides tienen buen pronóstico, 10 a 15% de los pacientes muestra recurrencia de la enfermedad e incluso 5% padece metástasis a distancia. Las metástasis cerebrales del cáncer de tiroides son raras y habitualmente conllevan mal pronóstico. OBJETIVO: describir las características demográficas y radiológicas, así como el pronóstico clínico de pacientes con cáncer de tiroides que requirieron consulta neurológica. MATERIAL Y MÉTODO: estudio prospectivo observacional en el que se incluyeron pacientes atendidos en un centro de referencia de tercer nivel con cáncer de tiroides que requirieron consulta neurológica entre enero de 2010 y enero de 2016. Se estudiaron las concentraciones séricas de tiroglobulina, TSH y anticuerpos anti-tiroglobulina, como se ha sugerido previamente. RESULTADOS: encontramos siete pacientes con metástasis cerebrales por cáncer de tiroides y las comparamos con registros encontrados en la bibliografía. El género masculino, la edad avanzada y las concentraciones elevadas de tiroglobulina se asociaron con mayor frecuencia de metástasis a distancia de cáncer de tiroides. CONCLUSIONES: las metástasis cerebrales de cáncer de tiroides son complicaciones poco frecuentes con pronóstico adverso. La tiroglobulina es un marcador tumoral muy útil para el seguimiento de pacientes con cáncer de tiroides ya que está elevada en pacientes con actividad sistémica y muy elevada en sujetos con metástasis cerebrales.
Abstract: BACKGROUND: Cancer is one of the first causes of both mortality and morbidity in the world. Thyroid cancer is the most common endocrine neoplasm. Although most TC patients have a good prognosis, 10 to 15% present recurrent disease and up to 5% show distant metastases. Brain metastases are unusual and are associated with a worse prognosis. OBJECTIVE: To describe the demographic and radiological characteristics, as well as clinical prognosis of patients with thyroid cancer who required neurological consultation. MATERIAL AND METHOD: A prospective observational study in which patients with thyroid cancer who required neurological consultation, attended in a tertiary referral cancer center, was done from January 2010 to January 2016. Serum levels of thyroglobulin, TSH and anti-thyroglobulin antibodies were studied, as suggested previously. RESULTS: We followed around 400 patients with TC and we found seven patients with brain metastases by thyroid cancer and compared them with records found in literature. Male gender, older age and high levels of thyroglobulin were associated with higher incidence of distant metastases of thyroid cancer. CONCLUSIONS: Brain metastases of thyroid cancer are little frequent complications with adverse prognosis. Thyroglobulin is a very useful tumoral marker for the following of patients with thyroid cancer, because it is high in patients with systemic activity and very high in patients with brain metastases.