Post-treatment neutrophil-to-lymphocyte ratio predicts for overall survival in brain metastases treated with stereotactic radiosurgery

Abstract

Introduction Neutrophil-to-lymphocyte ratio (NLR) is a surrogate for systemic inflammatory response and its elevation has been shown to be a poor prognostic factor in various malignancies. Stereotactic radiosurgery (SRS) can induce a leukocytepredominant inflammatory response. This study investigates the prognostic impact of post-SRS NLR in patients with brain métastasés (BM). Methods BM patients treated with SRS from 2003 to 2015 were retrospectively identified. NLR was calculated from the most recent full blood counts post-SRS. Overall survival (OS) and intracranial outcomes were calculated using the Kaplan-Meier method and cumulative incidence with competing risk for death, respectively. Results 188 patients with 328 BM treated with SRS had calculable post-treatment NLR values. Of these, 51 (27.1%) had a NLR >6. The overall median imaging follow-up was 13.2 (14.0 vs. 8.7 for NLR ≤ 6.0 vs. >6.0) months. Baseline patient and treatment characteristics were well balanced, except for lower rate of ECOG performance status 0 in the NLR > 6 cohort (33.3 vs. 44.2%, p = 0.026). NLR >6 was associated with worse 1- and 2-year OS: 59.9 vs. 72.9% and 24.6 vs. 43.8%, (p = 0.028). On multivariable analysis, NLR > 6 (HR: 1.53; 95% CI 1.03–2.26, p = 0.036) and presence of extracranial metastases (HR: 1.90; 95% CI 1.30–2.78; p < 0.001) were significant predictors for worse OS. No association was seen with NLR and intracranial outcomes. Conclusion Post-treatment NLR, a potential marker for post-SRS inflammatory response, is inversely associated with OS in patients with BM. If prospectively validated, NLR is a simple, systemic marker that can be easily used to guide subsequent management.

Peri-treatment peripheral blood cell score predicts long-term locoregional progression hazard in oesophageal squamous cell carcinoma after definitive chemoradiotherapy

“…Indeed, all parameters with significant discrimination capacity were collected after the start of RT, rather than at baseline. In line with our results, a number of recently published studies suggest that post-treatment PBC parameters are associated with outcomes of cancer patients after RT or immunotherapy [29][30][31][32][33][34][35]. Barbetta shows that integrating multiple PBC parameters could predict the survival of patients with adult Tlymphoblastic lymphoma [38].…”

Peri-treatment peripheral blood cell score predicts long-term locoregional progression hazard in oesophageal squamous cell carcinoma after definitive chemoradiotherapy

“…Indeed, all parameters with significant discrimination capacity were collected after the start of RT, rather than at baseline. In line with our results, a number of recently published studies suggest that post-treatment PBC parameters are associated with outcomes of cancer patients after RT or immunotherapy [3,9,21,25,27,32,40]. Barbetta A et al show that changes of NLR after CRT are associated with risk of recurrence in patients with oesophageal squamous cell carcinoma [3].…”

Relation of baseline neutrophil-to-lymphocyte ratio to survival and toxicity in head and neck cancer patients treated with (chemo-) radiation

“…Several studies involving HNSCC have shown an association between inflammation and worse prognosis [ 21 – 27 ]. However, information about the possible value of pretreatment NLR or PLR on toxicity is limited [ 18 – 29 ].…”