<p>The Clinical Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Brain Metastases from Non–Small Cell Lung Cancer-Harboring EGFR Mutations</p>

Abstract

Purpose Several studies have explored the correlation between the neutrophil-to-lymphocyte ratio (NLR) and the prognosis of patients with lung cancer. However, little is known about the correlation between the pretreatment NLR and the prognosis of patients with brain metastases from non–small cell lung cancer (NSCLC)-harboring mutations in the epidermal growth factor receptor ( EGFR ) gene. We sought to evaluate the predictive values in brain metastasis from lung adenocarcinoma with EGFR mutations. Methods We retrospectively examined 133 patients with brain metastases (BMs) from lung adenocarcinoma with EGFR mutations. NLR was calculated using N/L, where N and L, respectively, refer to peripheral blood neutrophil (N) and lymphocyte (L) counts. The cut-off value of NLR was assessed by the area under the curve (AUC). The Log rank test and Cox proportional hazard model were used to confirm the impact of NLR and other variables on survival. Results An NLR value equal to or less than 2.99 was associated with prolonged survival in this cohort of patients in both variable and multivariable analysis. Conclusion We concluded that NLR is an independent prognostic factor in BMs from lung adenocarcinoma with EGFR mutations. This could serve as a useful prognostic biomarker and could be incorporated in the clinical prognostic index specific to patients with BMs.

Preoperative neutrophil-to-lymphocyte ratio (preNLR) for the assessment of tumor characteristics in lung adenocarcinoma patients with brain metastasis

“…On univariate analysis of overall survival, elevated preNLR was an independent prognostic poor factor along with KPS < 70, extracerebral metastases, age ≥ 65, without postoperative radiotherapy and targeted therapy. These results have been supported by other studies [ 22 , 26 ]. When the high and low NLR groups are analyzed, it becomes apparent that preNLR is associated with the BM lesions of both supra- and infratentorial and the severe peritumoral edema, thereby causing severe neurological symptoms ( Fig.…”

“…In addition, previous studies have shown the prognostic value of NLR in other nervous system disorders, including glioblastoma [15] , traumatic brain injury [16] , Meningiomas [17] , Alzheimer's disease [18] and lymphoma [19] . The cutoff value of NLR reported in previous literature is around 2.0–7.0 [ 12 , 14 , [20] , [21] , [22] ]. However, few studies focused on the prognostic value of elevated preNLR in LUAD patients with BM.…”

Elevated neutrophil‐to‐lymphocyte ratio (NLR) is associated with poorer progression‐free survival in unresectable stage III NSCLC treated with consolidation durvalumab

“…A NLR threshold of 3 has been investigated in a number of trials in NSCLC to differentiate high and low risk patients. A recent example of this can be seen in a study which investigated the role of NLR in patients with stage IV disease with brain metastasis and found that pretreatment NLR ≥3 correlated with worsened overall survival 8 . The first data in the stage III NSCLC setting was published by Wang et al who also investigated the baseline prechemoradiotherapy NLR for patients treated with consolidation durvalumab.…”

“…NLR is calculated by the absolute neutrophil count divided by the absolute lymphocyte count. Based on previous studies, 8 , 13 we used a threshold ratio of 3 to define high and low NLR. Sustained NLR was defined as NLR ≥ 3 in both pre‐CRT and predurvalumab blood tests.…”

“…A number of studies have used a NLR of 3 to stratify high and low risk patients. 8 , 9 Further, dynamic changes in NLR have been investigated in other solid organ malignancies, with results suggesting that sustained NLR during and after initial chemotherapy is associated with poorer survival outcomes. 10 , 11 This has not previously been demonstrated in the NSCLC setting.…”