Brain and heart-specific death in cancer patients: Population-based study

Mohammed Safi, Murad Al-Nusaif, Dario Trapani, Mubarak A. Mashrah, Ravindran Kanesvaran, Aziz Alzandani, Mahmoud Al-Azab, Syed A. Mazher, Abdullah Al-Danakh, Jiwei Liu

Research output: Contribution to journalArticlepeer-review


Background: The occurrence of cardiovascular events is a major cause of death in patients with cancer. Small studies have documented a connection between specific brain alterations and autonomic cardiac dysfunctions, possibly resulting in a worse prognosis. We aimed to refine the knowledge of fatal cardiac events in patients with brain metastasis (BM). Methods: We performed a Surveillance, Epidemiology, and End Results SEER registry-based investigation (timeline: 2010–2016) and extracted all the advanced patients who had experienced fatal cardiac outcomes. Populations were compared according to the presence or not BM. Kaplan–Meier (KM) methodology was used for survival analysis and a multivariate model was developed by adjusting for multiple possible confounders. Results: Most related BM and cardiac death were observed at the site of lung cancer (81.4%). We extracted 3187 patients with lung cancer site, including 417 patients who had experienced fatal heart-specific with a history of BM, which is considered a BM group. The second group of heart-specific death included 2770 patients was stated as a non-BM group. Patients who had experienced heart-specific death in the BM group were predominately male, right side, upper site, and non-small type (62.11%, 54.92%, 51.56%, 69.78%), respectively. The survival outcomes between BM and the non- BM was significantly prominent (p = 0.003; median: 2 months vs. 3 months).The negative prognostic independent significance of heart-fatal events was confirmed after adjusting for multiple variables (HR = 0.76, CI = 0.68–84, p < 0.0001). The metastatic liver site was significantly associated with poorer survival rates (HR = 0.68; CI = 0.52–0.88, p = 0.005). We revealed a possible connection between the brain and heart functions. Conclusions: The prognosis of heart-specific death patients in BM is unfavorable compared to non-BM settings in lung cancer. We may be at the gates of a new field of neurocardiooncology.

Original languageEnglish (US)
Pages (from-to)5739-5747
Number of pages9
JournalCancer Medicine
Issue number17
StatePublished - Sep 2021


  • brain metastases
  • brain–heart axis
  • epidemiology
  • heart block
  • lung cancer

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


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