Systemic inflammation scores correlate with survival prognosis in patients with newly diagnosed brain metastases

Angelika M Starzer,Karin Dieckmann,Carola Deischinger,Georg Widhalm,Anika Simonovska,Ariane Steindl,Anna S Berghoff,Gerwin Heller,Maximilian J Mair,Brigitte Gatterbauer,Matthias Preusser

doi:10.1038/s41416-020-01254-0

Abstract

BackgroundSystemic inflammation measured by the neutrophil-to-lymphocyte ratio (NLR), leucocyte-to-lymphocyte ratio (LLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR) and CRP/albumin ratio (CRP/Alb) was shown to impact the survival prognosis in patients with extracranial solid cancer.MethodsOne thousand two hundred and fifty patients with newly diagnosed brain metastases (BM) were identified from the Vienna Brain Metastasis Registry.ResultsPLR and CRP/Alb were higher in patients with progressive extracranial disease and lower in patients with no evidence of extracranial disease. Lower NLR (cut-off = 5.07; 9.3 vs. 5.0 months), LLR (cut-off = 5.76; 10.0 vs. 5.3 months), PLR (cut-off = 335; 8.0 vs. 3.8 months), MLR (cut-off = 0.53; 6.0 vs. 3.5 months) and CRP/Alb (cut-off = 2.93; 8.5 vs. 3.7 months; padj < 0.05) were associated with longer overall survival (OS). In multivariate analysis with graded prognostic assessment (hazard ratio (HR) 1.45; 95% confidence interval (CI): 1.32–1.59; padj = 1.62e − 13), NLR (HR 1.55; 95% CI: 1.38–1.75; padj = 1.92e − 11), LLR (HR 1.57; 95% CI: 1.39–1.77; padj = 1.96e − 11), PLR (HR 1.60; 95% CI: 1.39–1.85; padj = 2.87955e − 9), MLR (HR 1.41; 95% CI: 1.14–1.75; padj = 0.027) and CRP/Alb (HR 1.83; 95% CI: 1.54–2.18; padj = 2.73e − 10) remained independent factors associated with OS at BM diagnosis.ConclusionsSystemic inflammation, measured by NLR, LLR, PLR, MLR and CRP/Alb, was associated with OS in patients with BM. Further exploration of immune modulating therapies is warranted in the setting of BM.

Highlights

Systemic inflammation measured by the neutrophil-to-lymphocyte ratio (NLR), leucocyte-to-lymphocyte ratio (LLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR) and CRP/albumin ratio (CRP/Alb) was shown to impact the survival prognosis in patients with extracranial solid cancer
One hundred and eight of 1250 (8.6%) patients showed no evidence of extracranial disease at Brain metastases (BMs) diagnosis, while stable extracranial disease at BM diagnosis was evident in 233/1250 (18.6%) patients
graded prognostic assessment (GPA) class showed a significant association with survival prognosis from diagnosis of BM in univariate analysis (hazard ratio (HR) 1.47; 95% confidence interval (CI): 1.35–1.62; padj = 2.10e − 15; Cox regression model); Supplementary Fig. 1)

Summary

Introduction

Systemic inflammation measured by the neutrophil-to-lymphocyte ratio (NLR), leucocyte-to-lymphocyte ratio (LLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR) and CRP/albumin ratio (CRP/Alb) was shown to impact the survival prognosis in patients with extracranial solid cancer. CONCLUSIONS: Systemic inflammation, measured by NLR, LLR, PLR, MLR and CRP/Alb, was associated with OS in patients with BM. The density of intratumoural T cells was described as a favourable prognostic factor in BM patients underscoring the prognostic importance of cancer–immune system interactions in patients with BM.[6] Recent insights into the cancer–immune system interactions further stressed the importance of systemic inflammation in addition to the local inflammatory characteristics.[7] Systemic inflammatory scores, including neutrophil-to-lymphocyte ratio (NLR), leucocyte-to-lymphocyte ratio (LLR), platelet-tolymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR) and

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