治疗后中性粒细胞与淋巴细胞比值可预测立体定向放疗治疗脑转移瘤的总生存期。
Post-treatment neutrophil-to-lymphocyte ratio predicts for overall survival in brain metastases treated with stereotactic radiosurgery.
机构信息
Department of Radiation Oncology, Rush University Medical Center, 500 South Paulina, Chicago, IL, 60612, USA.
Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
出版信息
J Neurooncol. 2018 Sep;139(3):689-697. doi: 10.1007/s11060-018-2914-5. Epub 2018 May 30.
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 leukocyte-predominant inflammatory response. This study investigates the prognostic impact of post-SRS NLR in patients with brain metastases (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.
简介
中性粒细胞与淋巴细胞比值（NLR）是全身炎症反应的替代指标，其升高已被证明是各种恶性肿瘤的预后不良因素。立体定向放射外科（SRS）可引起以白细胞为主的炎症反应。本研究探讨了 SRS 后 NLR 对脑转移瘤（BM）患者的预后影响。
方法
回顾性分析了 2003 年至 2015 年接受 SRS 治疗的 BM 患者。从 SRS 后最近的全血细胞计数中计算 NLR。使用 Kaplan-Meier 法计算总生存（OS）和颅内结局，使用累积发生率和竞争风险（死亡）分别计算无进展生存（PFS）。
结果
188 例 328 个 BM 患者接受 SRS 治疗，可计算治疗后 NLR 值。其中 51 例（27.1%）的 NLR > 6。总的中位影像学随访时间为 13.2 个月（14.0 个月 vs. NLR ≤ 6.0 组为 8.7 个月 vs. NLR > 6.0 组）。基线患者和治疗特征平衡良好，除 NLR > 6.0 组 ECOG 表现状态 0 率较低（33.3% vs. 44.2%，p = 0.026）。NLR > 6 与 1 年和 2 年 OS 较差相关：59.9% vs. 72.9%和 24.6% vs. 43.8%（p = 0.028）。多变量分析显示，NLR > 6（HR：1.53；95%CI 1.03-2.26，p = 0.036）和存在颅外转移（HR：1.90；95%CI 1.30-2.78；p < 0.001）是 OS 较差的显著预测因素。NLR 与颅内结局无相关性。
结论
SRS 后 NLR，一种潜在的 SRS 后炎症反应标志物，与 BM 患者的 OS 呈负相关。如果前瞻性验证，NLR 是一种简单的全身标志物，可用于指导后续治疗。
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