Wang Jia-Wei, Yuan Qing, Li Li, Cao Kai-Hua, Liu Qi, Wang Hong-Liang, Hu Ke, Wu Xi, Wan Jing-Hai
Department of Neurosurgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Medical Records Department, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Onco Targets Ther. 2023 Mar 23;16:179-187. doi: 10.2147/OTT.S402389. eCollection 2023.
Several biomarkers, such as baseline neutrophil-to-lymphocyte ratio (NLR), have been more investigated in patients with brain metastases (BM), while their role in patients with leptomeningeal metastases (LM) has not been clarified. Considering the difference between the clinical behaviour of BM and LM, there is the need for addressing the role of these biomarkers in LM.
The present study retrospectively analyzed 95 consecutive patients with LM from lung cancer who were diagnosed at the National Cancer Center, Cancer Hospital of Chinese Academy of Medical Sciences between January 2016 and December 2019. Baseline NLR, platelet-to-lymphocyte ratio (PLR), systemic immunoinflammation index (SII), and lymphocyte-to-monocyte ratio at diagnosis of LM were calculated based on complete blood count and correlated, along with other characteristics, with overall survival (OS) using univariate and multivariate analyses. The best cutoff values for systemic immunoinflammation biomarkers were derived using the surv_cutpoint function in R software, which optimized the significance of the split between Kaplan-Meier survival curves.
Median OS of patients with LM was 12 months (95% CI 9-17 months). On univariate analysis, NLR, PLR, SII, LMR, sex, smoking history, ECOG performance status (PS) scores, histological subtypes and targeted therapy were all significantly associated with OS. Only NLR (=0.034, 95% CI 1.060-4.578) and ECOG PS scores (=0.019, 95% CI 0.137-0.839) maintained a significant association with OS on multivariate analysis. Furthermore, patients with baseline NLR >3.57 had significantly worse OS than patients with NLR ≤3.57 (median OS 7 vs 17 months), as did patients with ECOG PS scores >2 vs ≤2 (median OS 4 vs 15 months).
Both baseline NLR and PS scores at the time of LM diagnosis are helpful and available prognostic biomarkers for patients with LM from lung cancer.
几种生物标志物，如基线中性粒细胞与淋巴细胞比值（NLR），在脑转移（BM）患者中得到了更多研究，但其在软脑膜转移（LM）患者中的作用尚未明确。考虑到BM和LM临床行为的差异，有必要探讨这些生物标志物在LM中的作用。
本研究回顾性分析了2016年1月至2019年12月在中国医学科学院肿瘤医院国家癌症中心确诊的95例连续的肺癌软脑膜转移患者。根据全血细胞计数计算LM诊断时的基线NLR、血小板与淋巴细胞比值（PLR）、全身免疫炎症指数（SII）和淋巴细胞与单核细胞比值，并与其他特征一起，采用单因素和多因素分析与总生存期（OS）进行相关性分析。使用R软件中的surv_cutpoint函数得出全身免疫炎症生物标志物的最佳截断值，该函数优化了Kaplan-Meier生存曲线之间分割的显著性。
LM患者的中位OS为12个月（95%CI 9 - 17个月）。单因素分析显示，NLR、PLR、SII、LMR、性别、吸烟史、东部肿瘤协作组（ECOG）体能状态（PS）评分、组织学亚型和靶向治疗均与OS显著相关。多因素分析中，只有NLR（=0.034，95%CI 1.060 - 4.578）和ECOG PS评分（=0.019，95%CI 0.137 - 0.839）与OS保持显著相关性。此外，基线NLR >3.57的患者OS明显低于NLR≤3.57的患者（中位OS分别为7个月和17个月），ECOG PS评分>2的患者与≤2的患者情况类似（中位OS分别为4个月和15个月）。
LM诊断时的基线NLR和PS评分均是肺癌软脑膜转移患者有用且可获得的预后生物标志物。
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