The preoperative neutrophil-to-lymphocyte ratio predictive value for survival in patients with brain metastasis

Abstract

Background The neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte ratio (PLR), and red blood cell distribution width (RDW) have been previously studied as predictors of survival in different malignancies. Objective The aim of this study was to evaluate the predictive value of these hematologic inflammatory biomarkers for patients with brain metastases (BM). Methods We reviewed a consecutive cohort of patients at Instituto do Cancer do Estado de São Paulo (ICESP-FMUSP) from 2011 to 2016 with ≥ 1 BM treated primarily by surgical resection. The primary outcome was 1-year survival. We optimized the NLR, MLR, PLR, and RDW cutoff values, preserving robustness and avoiding overestimation of effect size. Results A total of 200 patients (mean age 56.1 years; 55.0% female) met inclusion criteria. Gross-total resection was achieved in 89.0%. The median (quartiles) preoperative and postoperative KPS scores were 60 (50–80) and 80 (60–90), respectively. Preoperative NLR was significantly associated with survival (HR 2.66, 95% CI: 1.17–6.01, p = 0.019). A NLR cutoff value of 3.83 displayed the most significant survival curve split. Conclusions Preoperative NLR is an independent predictor of survival in newly diagnosed BM. We propose a cutoff value of 3.83 for preoperative NLR testing may be clinically useful as predictor of poor survival in this population. The wide accessibility of the NLR favors its inclusion in clinical decision-making processes for BM management.

The Relationship between Furin and Chronic Inflammation in the Progression of Cervical Intraepithelial Neoplasia to Cancer: A Cross-Sectional Study

“…The literature indicates that these inflammatory indices could be independently used to distinguish the preinvasive lesions in the larynx, cervix, and endometrium from their invasive counterparts [39][40][41]. Also, NLR, MLR, PLR, and SII could be used to predict certain cancer prognoses [16][17][18][19][20][21][22][23][24].…”

“…Even if the role of neutrophils in cancer is ambiguous, a high neutrophil-to-lymphocyte ratio (NLR) is related to a poorer prognosis for various cancers, such as breast cancer, colorectal cancer, malignant melanoma, and gynecological cancer [16,17]. Likewise, a high monocyte-to-lymphocyte ratio (MLR) and a high platelet-to-lymphocyte ratio (PLR) are also considered valuable prognostic markers in multiple cancers, such as head and neck, gastric, colorectal, and brain metastasis [18][19][20][21]. Recently, the systemic immune-inflammation index (SII), which takes into account the platelet count, has been regarded as a superior prognostic factor for solid tumors, such as esophageal, gynecological, and triple-negative breast cancer, and predicts the response to immunotherapy [22][23][24].…”

Sequential Evaluation of Hematology Markers as a Prognostic Factor in Glioblastoma Patients

“…Notably, NLR seems to be a more decisive prognostic marker than PLR in certain studies. [7][8][9] At the present study, we gathered data on NLR, PLR, Red Cell Distribution Width-Coefficient of Variation (RDW-CV at various stages including pre-operatively, post-operatively, and prior to specific adjuvant treatments. Our objective was to investigate the potential influence of these hematological markers on the Overall Survival (OS) and Progression-Free Survival (PFS) in glioblastoma patients, thereby contributing to a deeper understanding of their prognostic significance in this context.…”

Sequential Evaluation of Hematology Markers as a Prognostic Factor in Glioblastoma Patients

“…The findings from these studies have consistently revealed that elevated levels of the NLR and PLR before treatment are associated with less favorable outcomes in these patients. Notably, the NLR seems to be a more decisive prognostic marker than the PLR in certain studies [7][8][9].…”