Systematic Immunological Level Determined the Prognosis of Leptomeningeal Metastasis in Lung Cancer

Abstract

Background and Purpose Leptomeningeal metastases (LM) is the end-event of lung cancer and the prognosis is dismal. Few studies explored the prognostic performance of systematic immunological levels in lung cancer patients with LM. Our study aimed to explore the possible relationship between the prognosis of LM and systematic immunological level and other clinical characteristics. Methods This retrospective, multi-institutional, observational study was conducted in 4 tertiary centers in China. Patients were screened from January 2009 to May 2019. Patients with radiographically or histologically confirmed LM were enrolled. The data of systematic immunological level and other clinical characteristics of each patient were extracted and statistically analyzed to establish a prognostic model based on statistical analysis results. The predictive accuracy and discriminative capability of the model were evaluated by the calibration curve and concordance index (C-index). Results A total of 109 patients were enrolled in the study. Patients with adenocarcinoma, tumors harboring EGFR mutation, at their age of 50–59, with either bone, brain, or lung metastases, were enriched in this cohort. The median overall survival (OS) was 20.4 months (95% CI: 15.2–25.6). Cox univariate and multivariate analysis revealed better PS (0–1), no distant lymph nodes metastasis (DLNM), simultaneous diagnosis of lung cancer and leptomeningeal metastasis (SDLL), and lower neutrophil to lymphocyte ratio (NLR), were associated with better OS. Based on these independent prognostic variables, a prognostic nomogram model with a C-index for OS prediction of 0.71, was constructed. The actual probability of survival at 1-, 2- and 3-year showed good concordance with the prediction curve of our nomogram. Conclusion The systematic immunological level was an independent prognostic factor of lung cancer patients with LM. The prognostic model based on statistical analysis had a good ability to predict the OS of patients.

Brain parenchymal and leptomeningeal metastasis in non-small cell lung cancer

“…3 d). This result was consistent with our previous work, indicating that PM might be a risk factor for LM 18 . Although the mechanism beneath remained elusive, we reasonably inferred cancer cells evolved to acquire additional capabilities to accustomed to the hypoxic leptomeningeal compartment.…”

Brain parenchymal and leptomeningeal metastasis in lung cancer

“…3d). This result was consistent with our previous work, indicating that PM might be a risk factor for LM [17]. Although the mechanism beneath remained elusive, we reasonably inferred cancer cells evolved to acquire additional capabilities to accustomed to the hypoxic leptomeningeal compartment.…”

“…Younger age, EGFR L858R, no pleural metastases, adrenal gland metastases and elevated CEA were risk factors. Of notice, some factors were referenced in other studies as well, which might suggest the reliability of our model [17,19,20]. Our model was a comprehensive one, including factors from clinical (age and metastases) to laboratory ndings (EGFR mutation and tumor markers).…”

“…This imposes a distinct and profound selective pressure on tumour cells that, in turn, shapes the clinical characteristics and therapeutic responses [8]. However, few, if any, studies have been reported on whether their respective clinical characteristics, survival prognosis, and risk factors for occurrence are different [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Therefore, we conducted this study to comprehensively assess the clinical characteristics, survival prognosis, and risk factors of patients with advanced NSCLC who develop brain parenchymal metastases (PM) and leptomeningeal metastasis (LM).…”

Prognostic value of pre-treatment neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with brain metastasis from lung cancer: A systematic review and meta-analysis.

“…Eleven studies (23,24,(29)(30)(31)(32)(33)(34)(35)(36)(37) reported the association of NLR and OS in lung cancer patients with BM. The random effects model was applied because the test for heterogeneity showed signi cant heterogeneity among the included studies (P = 0.016, I 2 = 54.0%).…”