Abstract
PurposeTo investigate the clinical value of the inflammation based prognostic scores for patients with radiosurgically treated brain metastases (BM) originating from non-pulmonary primary tumor (PT).MethodsA retrospective analysis of 340 BM patients of different PT origin (melanoma, breast, gastrointestinal, or genitourinary cancer) was performed. Pre-radiosurgical laboratory prognostic scores, such as the Neutrophil-to-Lymphocyte Ratio (NLR), the Platelet-to-Lymphocyte Ratio (PLR), Lymphocyte-to-Monocyte Ratio (LMR), and the modified Glasgow Prognostic Score (mGPS), were investigated within 14 days before the first Gamma Knife radiosurgical treatment (GKRS1).ResultsIn our study cohort, the estimated survival was significantly longer in patients with NLR < 5 (p < 0.001), LMR > 4 (p = 0.001) and in patients with a mGPS score of 0 (p < 0.001). Furthermore, univariate and multivariate Cox regression models revealed NLR ≥ 5, LMR < 4 and mGPS score ≥ 1 as independent prognostic factors for an increased risk of death even after adjusting for age, sex, KPS, extracranial metastases status, presence of neurological symptoms and treatment with immunotherapy (IT) or targeted therapy (TT).ConclusionsSummarizing previously published and present data, pre-radiosurgical mGPS and NLR groups seem to be the most effective and simple independent prognostic factors to predict clinical outcome in radiosurgically treated BM patients.
Highlights
Over the last decades, there has been an increase in the incidence of brain metastses (BM) due to improvements in diagnostic workups, and in systemic oncological therapies [1]
The estimated median survival time was 56.0 months [95% confidence interval (CI) = 46.3–65.8] after the initial diagnosis of the primary tumor (PT), 12.0 months after the initial diagnosis of BMs, and 9.1 months after GKRS1
Despite the improvements in the management of cancer patients, the prognosis of patients with BM remains poor as it is still associated with short survival duration [17]
Summary
There has been an increase in the incidence of brain metastses (BM) due to improvements in diagnostic workups, and in systemic oncological therapies [1]. Lung cancer represents the most common primary tumor (PT), the incidence of BM from other PT, such as melanoma, breast, renal, colorectal cancer should not be underestimated [1, 2]. 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]. 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]
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