Related Experiment Video
Updated: Jul 8, 2026
Modeling Brain Metastases Through Intracranial Injection and Magnetic Resonance Imaging
Published on: June 7, 2020
Intratumoral hemorrhage in patients with brain metastasis from systemic tumors: risk factors and prognostic
Bettina Grossenbacher1, Emilie Le Rhun2, Patrick Roth1
1Department of Neurology, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, Zurich, CH-8091, Switzerland.
Insights
Brain metastases hemorrhage risk is linked to tumor type and antiplatelet use, not traditional factors. A new score predicts this bleeding better than existing models.
Area of Science:
- Oncology
- Neurology
- Clinical Risk Stratification
Background:
- Intracerebral hemorrhage (ICH) is a significant complication in patients with brain metastases (BM).
- Current risk stratification tools for hemorrhage are inadequate for BM patients.
- Existing scores like HAS-BLED lack validation in this specific population.
Purpose of the Study:
- To identify specific risk factors for intratumoral hemorrhage in brain metastases.
- To develop a novel predictive model for BM hemorrhage.
- To evaluate the performance of existing hemorrhage scores in BM patients.
Main Methods:
- Retrospective cohort study of 806 adult patients with BM (2004-2014).
- Multivariate regression analysis to identify independent risk factors for BM hemorrhage.
- Receiver operating characteristic (ROC) analysis to assess predictive performance of novel and existing scores.
Main Results:
- BM hemorrhage occurred in 11.9% of patients.
- Independent risk factors identified: multiple BM, melanoma or seminoma histology, and antiplatelet therapy.
- A novel BM-specific score demonstrated superior predictive performance (AUC 0.75) compared to HAS-BLED (AUC 0.54).
Conclusions:
- BM hemorrhage is driven by tumor characteristics and antiplatelet therapy, not traditional bleeding risks.
- Conventional hemorrhage scores are unsuitable for predicting BM hemorrhage.
- The developed BM-specific risk score offers improved prediction for clinical decision-making.
Purpose:
Intracerebral hemorrhage (ICH) is a serious complication in patients with brain metastases (BM), yet reliable risk stratification tools are lacking. Existing hemorrhage scores, such as HAS-BLED, were developed for cardiovascular populations and have not been validated for BM. We aimed to identify specific risk factors for intratumoral hemorrhage in BM and to develop a predictive model.
Methods:
We conducted a retrospective cohort study of 806 adult patients diagnosed with BM between 2004 and 2014 at a single tertiary centre. Intratumoral ICH events unrelated to surgery, referred to as BM hemorrhage, were analyzed. Multivariate regression analysis identified independent risk factors. Predictive performance of existing hemorrhage scores and a newly derived score was assessed using receiver operating characteristic (ROC) analysis.
Results:
BM hemorrhage occurred in 96 of 806 patients (11.9%). Independent risk factors included multiple BM (OR 2.1), primary tumor histology of melanoma (OR 5.0) or seminoma (OR 7.0), and antiplatelet therapy (OR 2.1). Anticoagulation, cardiovascular risk factors, radiotherapy, chemotherapy, anti-VEGF therapy, and steroids were not associated with hemorrhage risk. A novel BM-specific score derived from these factors showed a significant discrimination (AUC 0.75), outperforming HAS-BLED (AUC 0.54) and other established models.
Conclusion:
BM hemorrhage is primarily driven by tumor-related characteristics and antiplatelet therapy rather than traditional bleeding risk factors. Conventional hemorrhage scores are not suitable for this population. The proposed BM-specific risk score provides improved prediction and may support individualized risk assessment and clinical decision-making. Prospective validation is warranted.
More Related Videos
Related Concept Videos
02:30Metastasis
Epithelial-to-Mesenchymal Transition
The epithelial-to-mesenchymal transition or EMT is a developmental process commonly observed in wound healing, embryogenesis, and cancer metastasis. EMT is induced by transforming growth factor-beta (TGF-β) or receptor tyrosine kinase (RTK) ligands, which further...
01:17Hemorrhagic Stroke l: Introduction
01:29Hemorrhagic Stroke ll: Pathophysiology