Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Divisão de Neurocirurgia, São Paulo SP, Brazil.
Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto do Câncer de São Paulo, São Paulo SP, Brazil.
Arq Neuropsiquiatr. 2022 Sep;80(9):922-928. doi: 10.1055/s-0042-1755324. Epub 2022 Oct 4.
The neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte ratio (PLR), and red blood cell distribution width (RDW) have been previously studied as predictors of survival in different malignancies.
The aim of this study was to evaluate the predictive value of these hematologic inflammatory biomarkers for patients with brain metastases (BM).
We reviewed a consecutive cohort of patients at Instituto do Cancer do Estado de São Paulo (ICESP-FMUSP) from 2011 to 2016 with ≥ 1 BM treated primarily by surgical resection. The primary outcome was 1-year survival. We optimized the NLR, MLR, PLR, and RDW cutoff values, preserving robustness and avoiding overestimation of effect size.
A total of 200 patients (mean age 56.1 years; 55.0% female) met inclusion criteria. Gross-total resection was achieved in 89.0%. The median (quartiles) preoperative and postoperative KPS scores were 60 (50-80) and 80 (60-90), respectively. Preoperative NLR was significantly associated with survival (HR 2.66, 95% CI: 1.17-6.01, = 0.019). A NLR cutoff value of 3.83 displayed the most significant survival curve split.
Preoperative NLR is an independent predictor of survival in newly diagnosed BM. We propose a cutoff value of 3.83 for preoperative NLR testing may be clinically useful as predictor of poor survival in this population. The wide accessibility of the NLR favors its inclusion in clinical decision-making processes for BM management.
中性粒细胞与淋巴细胞比值（NLR）、单核细胞与淋巴细胞比值（MLR）、血小板与淋巴细胞比值（PLR）和红细胞分布宽度（RDW）已被研究为不同恶性肿瘤患者生存的预测因子。
本研究旨在评估这些血液炎症生物标志物对脑转移瘤（BM）患者的预测价值。
我们回顾了 2011 年至 2016 年在圣保罗州癌症研究所（ICESP-FMUSP）连续接受治疗的至少 1 个 BM 的患者队列，这些患者主要通过手术切除治疗。主要结果是 1 年生存率。我们优化了 NLR、MLR、PLR 和 RDW 的截断值，保持稳健性并避免高估效应大小。
共有 200 名患者（平均年龄 56.1 岁；55.0%为女性）符合纳入标准。89.0%的患者达到了大体全切除。术前和术后的 KPS 评分中位数（四分位数间距）分别为 60（50-80）和 80（60-90）。术前 NLR 与生存显著相关（HR 2.66，95%CI：1.17-6.01，P=0.019）。NLR 截断值为 3.83 时，生存曲线的差异最为显著。
术前 NLR 是新诊断 BM 患者生存的独立预测因子。我们建议术前 NLR 检测的截断值为 3.83，可能对该人群的不良生存预测具有临床意义。NLR 的广泛可及性有利于将其纳入 BM 管理的临床决策过程。
