Pre-radiosurgery leucocyte ratios and modified glasgow prognostic score predict survival in non-small cell lung cancer brain metastases patients

Abstract

Introduction The predictive value of the pre-radiosurgery Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Lymphocyte-to-Monocyte Ratio (LMR) and the modified Glasgow Prognostic Score (mGPS) was assessed for the first time in a homogenous group of NSCLC brain metastaes (BM) patients. Methods We retrospectively evaluated 185 NSCLC-BM patients, who were treated with Gamma Knife Radiosurgery (GKRS). Patients with immunotherapy or targeted therapy were excluded. Routine laboratory parameters were reviewed within 14 days before GKRS1. Results Median survival after GKRS1 was significantly longer in patients with NLR < 5 (p < 0.001), PLR < 180 (p = 0.003) and LMR ≥ 4 (p = 0.023). The Cox regression model for the continuous metric values revealed that each increase in the NLR of 1 equaled an increase of 4.3% in risk of death (HR: 1.043; 95%CI = 1.020–1.067, p < 0.001); each increase in the PLR of 10 caused an increase of 1.3% in risk of death (HR: 1.013; 95%CI = 1.004–1.021; p = 0.003) and each increase in the LMR of 1 equaled a decrease of 20.5% in risk of death (HR: 0.795; 95%CI = 0.697–0.907; p = 0.001). Moreover, the mGPS group was a highly significant predictor for survival after GKRS1 (p < 0.001) with a HR of 2.501 (95%CI = 1.582–3.954; p < 0.001). NLR, PLR, LMR values and mGPS groups were validated as independent prognostic factors for risk of death after adjusting for sex, KPS, age and presence of extracranial metastases. Conclusion NLR, PLR, LMR and mGPS represent effective and simple tools to predict survival in NSCLC patients prior to radiosurgery for brain metastases.

The clinical relevance of laboratory prognostic scores for patients with radiosurgically treated brain metastases of non-pulmonary primary tumor

“…For this retrospective study, patients who have been treated between June 2012 (implementation of the new Gamma Knife® Perfexion™ at our institution) and December 2019 were included. Our inclusion criteria were patients with an age > 18 years, at least one Gamma Knife radiosurgical (GKRS) treatment for at least one BM from melanoma, breast cancer, gastrointestinal (GI) or genitourinary (GU) cancer, and available laboratory parameters within 14 days before the first GKRS (GKRS1) [ 7 ].…”

“…Subsequently, all patients with available laboratory findings for the calculation of NLR, PLR, and LMR, were classified according to the previously defined cut-off-values. The cut-off values were 5 for NLR, 180 for PLR and 4 for LMR [ 4 , 7 , 13 ]. As previously reported, the mGPS was defined as follows: no abnormalities in CRP (≤ 10 mg/l) and albumin (≥ 35 g/l) was classified as a mGPS score of 0, while both abnormalities were classified as a mGPS score of 2.…”

“…Univariate and multivariate Cox proportional hazard regression analyses were performed to estimate the association of the prognostic scores with mortality and to evaluate for potential confounding clinical parameters. Multivariate Cox regression analyses included sex, age group (≤ 65 vs. > 65a), KPS group (< 80% vs. ≥ 80%), the presence of extracranial metastases (ECM), the presence of neurological symptoms (asymptomatic versus symptomatic patients), the NLR, PLR, LMR, and mGPS groups [ 7 ].…”

“…The median treatment volume was 0.6 cm 3 (0.1-29.0). The prescribed doses mainly targeted the 50% (45-90) isodose line, with a median prescription dose of 18 Gy (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)) and a median central dose of 32 Gy .…”

“…Therefore, leucocyte-based ratios, such as the Neutrophilto-Lymphocyte Ratio (NLR), the Platelet-to-Lymphocyte Ratio (PLR), and the Lymphocyte-to-Monocyte Ratio (LMR), have been previously reported to be prognostic for overall survival in patients with surgically treated BM [4,6]. However, the clinical data on NLR, PLR and LMR for radiosurgically treated BM patients are still mainly limited to non-small cell lung cancer (NSCLC) patients [7][8][9].…”