Yomo Shoji, Oda Kyota, Oguchi Kazuhiro
1Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto City, Nagano Prefecture, Japan; and.
2Positron Imaging Center, Aizawa Hospital, Matsumoto City, Nagano Prefecture, Japan.
J Neurosurg. 2024 Aug 23;142(2):454-463. doi: 10.3171/2024.5.JNS24259. Print 2025 Feb 1.
Treatment with immune checkpoint inhibitors (ICIs) has shown clinical benefit for a wide range of cancer types. The neutrophil-to-lymphocyte ratio (NLR) reportedly correlates with survival time or progression-free survival in patients treated with ICIs. However, NLR has not yet been assessed in patients with brain metastases (BMs) receiving stereotactic radiosurgery (SRS) combined with concurrent ICIs. The authors investigated the predictive impact of NLR on the survival data of patients with BMs who received SRS with concurrent ICIs.
The clinical records of patients who had undergone SRS with concurrent ICIs for BMs between January 2015 and August 2023 were retrospectively analyzed. NLR was calculated using the data obtained from the last examination prior to SRS. The optimal NLR cutoff value was identified by receiver operating characteristic (ROC) curve analysis for time-to-event data (overall survival [OS] ≤ 18 months). OS and intracranial disease progression-free survival (IC-PFS) rates were compared between the two NLR groups.
Of the 185 eligible patients included, 132 were male. The median (IQR) patient age was 69 (61-75) years. The primary cancers were lung, genitourinary, skin, breast, gastrointestinal, and others in 132, 23, 22, 2, 2, and 4 patients, respectively. The post-SRS median OS and IC-PFS times for the entire cohort were 18.4 (95% CI 14.0-23.1) months and 9.2 (95% CI 6.9-10.8) months, respectively. ROC curve analysis identified the optimal NLR cutoff value for 18-month OS to be 5.0 (area under the curve 0.64, Youden index 0.31). Kaplan-Meier analysis revealed that patients with high NLR (> 5) had a significantly shorter OS (median survival time 10.9 months for 48 patients vs 22.2 months for 137 patients, HR 2.0, 95% CI 1.3-3.0, p < 0.001). Similarly, a significant difference in median IC-PFS was noted: 4.8 months with high NLR versus 10.7 months with low NLR (HR 1.7, 95% CI 1.2-2.5, p = 0.003).
The authors found elevated pre-SRS NLR (> 5) to be associated with shorter OS and IC-PFS after SRS with concurrent ICIs for BMs. NLR is a simple, cost-effective, and widely accessible biomarker, which can thus be used for managing patients with BMs receiving SRS concurrently with ICIs. Further investigation in other large datasets is, however, required to validate these findings.
免疫检查点抑制剂（ICI）治疗已显示对多种癌症类型具有临床益处。据报道，中性粒细胞与淋巴细胞比值（NLR）与接受ICI治疗的患者的生存时间或无进展生存期相关。然而，尚未对接受立体定向放射外科治疗（SRS）联合同步ICI治疗的脑转移瘤（BM）患者的NLR进行评估。作者研究了NLR对接受SRS联合同步ICI治疗的BM患者生存数据的预测影响。
回顾性分析2015年1月至2023年8月期间因BM接受SRS联合同步ICI治疗的患者的临床记录。使用SRS前最后一次检查获得的数据计算NLR。通过对事件发生时间数据（总生存期[OS]≤18个月）的受试者工作特征（ROC）曲线分析确定最佳NLR临界值。比较两个NLR组之间的OS和颅内疾病无进展生存期（IC-PFS）率。
在纳入的185例符合条件的患者中，132例为男性。患者年龄中位数（IQR）为69（61-75）岁。原发癌分别为肺癌、泌尿生殖系统癌、皮肤癌、乳腺癌、胃肠道癌和其他癌症，患者分别为132例、23例、22例、2例、2例和4例。整个队列SRS后的中位OS和IC-PFS时间分别为18.4（95%CI 14.0-23.1）个月和9.2（95%CI 6.9-10.8）个月。ROC曲线分析确定18个月OS的最佳NLR临界值为5.0（曲线下面积0.64，约登指数0.31）。Kaplan-Meier分析显示，NLR高（>5）的患者OS明显较短（48例患者的中位生存时间为10.9个月，而137例患者为22.2个月，HR 2.0，95%CI 1.3-3.0，p<0.001）。同样，中位IC-PFS也存在显著差异：NLR高者为4.8个月，NLR低者为10.7个月（HR 1.7，95%CI 1.2-2.5，p=0.003）。
作者发现，对于因BM接受SRS联合同步ICI治疗的患者，SRS前NLR升高（>5）与较短的OS和IC-PFS相关。NLR是一种简单、经济高效且易于获取的生物标志物，因此可用于管理接受SRS联合ICI同步治疗的BM患者。然而，需要在其他大型数据集中进行进一步研究以验证这些发现。
