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Purpose <p>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.</p> Methods <p>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.</p> Results <p>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.</p> Conclusion <p>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.</p>

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Intratumoral hemorrhage in patients with brain metastasis from systemic tumors: risk factors and prognostic assessment

  • 期刊论文

  • 发表日期：

    2026年7月7日

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  • Bettina Grossenbacher,
  • Emilie Le Rhun,
  • Patrick Roth,
  • Zsolt Kulcsar,
  • Michael Weller,
  • Fabian Wolpert

摘要

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.