Abstract
OBJECTIVES: To investigate the clinical features and prognosis of patients with malignant tumor-associated acute cerebral infarction (MACI). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.