Moderate to severe TBI is associated with elevated malignant brain tumor risk

1. In this retrospective cohort study, moderate to severe traumatic brain injury (TBI) was associated with an increased risk of malignant brain tumour development compared to mild TBI and no TBI.

2. Among the TBI group, a larger number of individuals had a mild TBI compared to a moderate to severe TBI.

Evidence Rating Level: 2 (Good) 

Study Rundown: Traumatic Brain Injury (TBI) has substantial prevalence among the general population and results in increased morbidity and mortality, though the mechanism is not fully understood. Brain tumors, though only confirmed to have an increased risk through ionizing radiation, have shown a potential link through TBI. Studies of military populations, a population with high TBI prevalence, have been limited by confounding factors. To shed some light on inconclusive population studies and to increase early detection of brain tumors, this study investigated whether a link between TBI and malignant brain tumors could be established. This retrospective cohort study used data from US adult civilians across a variety of trauma centres, using codes from the Centers for Disease Control and Prevention for TBI and malignant tumors. Among the exposure group, the majority of the participants had a mild TBI compared to a moderate to severe TBI. Furthermore, there was a larger number of participants in the moderate to severe TBI group who developed a malignant brain tumor compared to the mild TBI group and the control group. One limitation of the study was the inability to determine the specific types of malignant brain tumor associated with TBI. Despite this, the study found that a history of moderate to severe TBI was associated with a future risk of malignant brain tumor development. These results indicate that adults with a history of moderate to severe TBI may benefit from enhanced monitoring and follow-up to identify potential development of malignant brain tumors. To tackle the limitations of this study, future research into screening programs for TBI patients is recommended.

Click here to read the study in JAMA Network Open

Relevant Reading: Traumatic Brain Injury and Subsequent Risk of Brain Cancer in US Veterans of the Iraq and Afghanistan Wars

In-Depth [retrospective cohort study]: This retrospective cohort study was conducted on 151,358 individuals, split into two equal cohorts of 75,679 participants per group. Participants were included if they were aged 18 years or older and had two or more visits for TBI. Inclusion in the study was limited to a 1-year observation period and a history of prior radiation exposure. Among the Mass General Brigham (MGB) group, the median follow-up time was 7.2 (IQR, 4.1-10.1) years. In the TBI group, 80.3% of participants had mild TBI, and 19.7% had moderate to severe TBI. the incidence of malignant brain tumors was greater in individuals with moderate to severe TBI (87 [0.6%]) compared to those with mild TBI (222 [0.4%]) and the control group (314 [0.4%]) (P=.001). Among matched individuals, the moderate to severe TBI group had a higher rate of malignant brain tumors (87 [0.6%]) compared to the control group (64 [0.4%]) (P=.003). In the regression analysis, individuals with moderate to severe TBI had a significantly higher risk of developing malignant brain tumors (HR, 1.67; 95% CI, 1.31-2.12; P<.001) compared with those with mild TBI (HR, 0.99; 95% CI, 0.83-1.18), independent of confounding factors. Overall, these findings support the need for ongoing monitoring of individuals with moderate to severe TBI to help with earlier detection of malignant brain tumors. 

Image: PD

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