Clinical features and prognosis of patients with malignant tumors complicated by cerebral infarction

To investigate the clinical features and prognosis of patients with malignant tumor-associated acute cerebral infarction (MACI).

This retrospective study compared 115 patients with MACI and 182 patients with simple acute cerebral infarction (ACI) admitted to the First Hospital of Zhangjiakou from January 2020 to December 2024. A comparison was made of the differences in demographic characteristics and prognosis survival rate between the two groups.

Non-small cell lung cancer (43.48%) was the most common malignant tumor in MACI patients. Compared with ACI patients, MACI patients had a higher prevalence of stroke history but a lower incidence of diabetes and hyperlipidemia. Imaging findings revealed a higher proportion of cortical/subcortical lesions and the typical diffusion-weighted imaging three-territory sign in the MACI group. Laboratory analyses demonstrated significantly elevated levels of D-dimer (D-D), fibrinogen (FIB), tissue factor (TF), plasminogen activator inhibitor-1 (PAI-1), and C-reactive protein in MACI patients. In the MACI group yielding an overall mortality rate of 62.61%, significantly higher than the 25.82% in the ACI group (P < 0.001). Multivariate Cox regression analysis identified TNM stage (HR = 2.127, 95% CI: 1.091-4.146), objective response rate (HR = 0.235, 95% CI: 0.088-0.621), D-D (HR = 2.320, 95% CI: 1.288-4.179), and National Institutes of Health Stroke Scale (NIHSS) score at admission (HR = 2.324, 95% CI: 1.215-4.444) as independent factors influencing overall survival in MACI patients.

MACI has unique clinical and radiological characteristics. The presence of the three-territory sign and a hypercoagulable state are key factors increasing cumulative mortality from ACI.