nach oben

Journal of Neuro-Oncology

Erschienen in:

06.04.2020 | Clinical Study

Pre-stereotactic radiosurgery neutrophil-to-lymphocyte ratio is a predictor of the prognosis for brain metastases

verfasst von: Lifeng Zhang, Yanjia Hu, Wei Chen, Yuan Tian, Yuebin Xie, Jing Chen

Erschienen in: Journal of Neuro-Oncology | Ausgabe 3/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The neutrophil-to-lymphocyte ratio (NLR) has been reported to relate to the prognosis of various cancers. The aim of this study was to elucidate the efficiency of pre-treatment NLR as a predictor of outcomes of brain metastasis underwent gamma knife radiosurgery (GKRS).

Methods

We analyzed 195 cases with brain metastasis underwent GKRS at our institution between January 2015 and April 2018. Patients’ clinical and radiographic data were collected.

Results

We identified 458 brain metastases in 195 patients. Optimal dichotomous cutoff values of NLR determined by receiver operating characteristic analysis for local control, distant control and overall survival (OS) were 2.48, 2.74 and 3.13, respectively. The actuarial local control rates of patients with high NLR were 87.4% at 6 months and 76.1% at 12 months, whereas that of patients with low NLR were 94.2% at 6 months and 88.3% at 12 months (P = 0.001). The actuarial distant control rates of patients with high NLR were 31.4% at 6 months and 18.9% at 12 months, whereas that of patients with low NLR were 58.5% at 6 months and 31.3% at 12 months (P = 0.001). The median OS of patients with high and low NLR were 10.0 months and 14.5 months, respectively (P = 0.001). Multivariate analysis demonstrates that high NLR independently predicts local failure (hazard ratio [HR], 2.281; P = 0.003), distant brain failure (HR 1.775; P = 0.002) and poorer overall survival (HR 1.494; P = 0.034).

Conclusion

The pre-SRS NLR, a systemic inflammatory marker for treatment response, inversely predicts local control, distant control and OS in patients with brain metastasis.

Aoyama H, Shirato H, Tago M et al (2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 295:2483–2491. https://doi.org/10.1001/jama.295.21.2483 CrossRefPubMed

Cagney DN, Martin AM, Catalano PJ et al (2017) Incidence and prognosis of patients with brain metastases at diagnosis of systemic malignancy: a population-based study. Neuro Oncol 19:1511–1521. https://doi.org/10.1093/neuonc/nox077 CrossRefPubMedPubMedCentral

Brown PD, Jaeckle K, Ballman KV et al (2016) Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA 316:401–409. https://doi.org/10.1001/jama.2016.9839 CrossRefPubMedPubMedCentral

Doron H, Pukrop T, Erez N (2019) A blazing landscape: neuroinflammation shapes brain metastasis. Cancer Res 79:423–436. https://doi.org/10.1158/0008-5472.CAN-18-1805 CrossRefPubMedPubMedCentral

Owonikoko TK, Arbiser J, Zelnak A et al (2014) Current approaches to the treatment of metastatic brain tumours. Nat Rev Clin Oncol 11:203–222. https://doi.org/10.1038/nrclinonc.2014.25 CrossRefPubMedPubMedCentral

Scoccianti S, Ricardi U (2012) Treatment of brain metastases: review of phase III randomized controlled trials. Radiother Oncol 102:168–179. https://doi.org/10.1016/j.radonc.2011.08.041 CrossRefPubMed

Sperduto PW, Kased N, Roberge D et al (2012) Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 30:419–425. https://doi.org/10.1200/JCO.2011.38.0527 CrossRefPubMed

Eichler AF, Chung E, Kodack DP, Loeffler JS, Fukumura D, Jain RK (2011) The biology of brain metastases-translation to new therapies. Nat Rev Clin Oncol 8:344–356. https://doi.org/10.1038/nrclinonc.2011.58 CrossRefPubMedPubMedCentral

Patchell RA, Tibbs PA, Regine WF et al (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280:1485–1489. https://doi.org/10.1001/jama.280.17.1485 CrossRefPubMed

10.

Gempt J, Gerhardt J, Toth V et al (2013) Postoperative ischemic changes following brain metastasis resection as measured by diffusion-weighted magnetic resonance imaging. J Neurosurg 119:1395–1400. https://doi.org/10.3171/2013.9.JNS13596 CrossRefPubMed

11.

Baschnagel AM, Meyer KD, Chen PY et al (2013) Tumor volume as a predictor of survival and local control in patients with brain metastases treated with Gamma Knife surgery. J Neurosurg 119:1139–1144. https://doi.org/10.3171/2013.7.JNS13431 CrossRefPubMed

12.

Jani A, Rozenblat T, Yaeh AM et al (2015) The energy index does not affect local control of brain metastases treated by gamma knife stereotactic radiosurgery. Neurosurgery 77:119–125. https://doi.org/10.1227/NEU.0000000000000750 (discussion 25)CrossRefPubMed

13.

Minniti G, Scaringi C, Paolini S et al (2016) Single-fraction versus multifraction (3 × 9 Gy) stereotactic radiosurgery for large (%3e 2 cm) brain metastases: a comparative analysis of local control and risk of radiation-induced brain necrosis. Int J Radiat Oncol Biol Phys 95:1142–1148. https://doi.org/10.1016/j.ijrobp.2016.03.013 CrossRefPubMed

14.

Oermann EK, Kress MA, Todd JV et al (2013) The impact of radiosurgery fractionation and tumor radiobiology on the local control of brain metastases. J Neurosurg 119:1131–1138. https://doi.org/10.3171/2013.8.JNS122177 CrossRefPubMed

15.

Gaspar L, Scott C, Rotman M et al (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751. https://doi.org/10.1016/s0360-3016(96)00619-0 CrossRefPubMed

16.

Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W (2008) A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys 70:510–514. https://doi.org/10.1016/j.ijrobp.2007.06.074 CrossRefPubMed

17.

Mitsuya K, Nakasu Y, Kurakane T, Hayashi N, Harada H, Nozaki K (2017) Elevated preoperative neutrophil-to-lymphocyte ratio as a predictor of worse survival after resection in patients with brain metastasis. J Neurosurg 127:433–437. https://doi.org/10.3171/2016.8.JNS16899 CrossRefPubMed

18.

Cannon NA, Meyer J, Iyengar P et al (2015) Neutrophil-lymphocyte and platelet-lymphocyte ratios as prognostic factors after stereotactic radiation therapy for early-stage non-small-cell lung cancer. Journal of Thoracic Oncology 10:280–285. https://doi.org/10.1097/Jto.0000000000000399 CrossRefPubMed

19.

Lopes M, Carvalho B, Vaz R, Linhares P (2018) Influence of neutrophil-lymphocyte ratio in prognosis of glioblastoma multiforme. J Neurooncol 136:173–180. https://doi.org/10.1007/s11060-017-2641-3 CrossRefPubMed

20.

Koh CH, Bhoo-Pathy N, Ng KL et al (2015) Utility of pre-treatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as prognostic factors in breast cancer. Br J Cancer 113:150–158. https://doi.org/10.1038/bjc.2015.183 CrossRefPubMedPubMedCentral

21.

Grenader T, Waddell T, Peckitt C et al (2016) Prognostic value of neutrophil-to-lymphocyte ratio in advanced oesophago-gastric cancer: exploratory analysis of the REAL-2 trial. Ann Oncol 27:687–692. https://doi.org/10.1093/annonc/mdw012 CrossRefPubMed

22.

Gemenetzis G, Bagante F, Griffin JF et al (2017) Neutrophil-to-lymphocyte ratio is a predictive marker for invasive malignancy in intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 266:339–345. https://doi.org/10.1097/Sla.0000000000001988 CrossRefPubMed

23.

Kim JH, Lee JY, Kim HK et al (2017) Prognostic significance of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with stage III and IV colorectal cancer. World J Gastroenterol 23:505–515. https://doi.org/10.3748/wjg.v23.i3.505 CrossRefPubMedPubMedCentral

24.

Koh YW, Choi JH, Ahn MS, Choi YW, Lee HW (2016) Baseline neutrophil-lymphocyte ratio is associated with baseline and subsequent presence of brain metastases in advanced non-small-cell lung cancer. Sci Rep 6:38585. https://doi.org/10.1038/srep38585 CrossRefPubMedPubMedCentral

25.

Chowdhary M, Switchenko JM, Press RH et al (2018) Post-treatment neutrophil-to-lymphocyte ratio predicts for overall survival in brain metastases treated with stereotactic radiosurgery. J Neurooncol 139:689–697. https://doi.org/10.1007/s11060-018-2914-5 CrossRefPubMedPubMedCentral

26.

Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247. https://doi.org/10.1016/j.ejca.2008.10.026 CrossRefPubMed

27.

Sneed PK, Mendez J, Vemer-van den Hoek JG et al (2015) Adverse radiation effect after stereotactic radiosurgery for brain metastases: incidence, time course, and risk factors. J Neurosurg 123:373–386. https://doi.org/10.3171/2014.10.JNS141610 CrossRefPubMed

28.

Ly D, Bagshaw HP, Anker CJ et al (2015) Local control after stereotactic radiosurgery for brain metastases in patients with melanoma with and without BRAF mutation and treatment. J Neurosurg 123:395–401. https://doi.org/10.3171/2014.9.JNS141425 CrossRefPubMed

29.

Grandhi R, Kondziolka D, Panczykowski D et al (2012) Stereotactic radiosurgery using the Leksell Gamma Knife Perfexion unit in the management of patients with 10 or more brain metastases. J Neurosurg 117:237–245. https://doi.org/10.3171/2012.4.JNS11870 CrossRefPubMed

30.

Romano KD, Trifiletti DM, Garda A et al (2017) Choosing a prescription isodose in stereotactic radiosurgery for brain metastases: implications for local control. World Neurosurg 98(761–7):e1. https://doi.org/10.1016/j.wneu.2016.11.038 CrossRef

31.

Black PM, Johnson MD (2004) Surgical resection for patients with solid brain metastases: current status. J Neurooncol 69:119–124. https://doi.org/10.1023/b:neon.0000041875.09048.e7 CrossRefPubMed

32.

Arita H, Narita Y, Miyakita Y, Ohno M, Sumi M, Shibui S (2014) Risk factors for early death after surgery in patients with brain metastases: reevaluation of the indications for and role of surgery. J Neurooncol 116:145–152. https://doi.org/10.1007/s11060-013-1273-5 CrossRefPubMed

33.

Linskey ME, Andrews DW, Asher AL et al (2010) The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96:45–68. https://doi.org/10.1007/s11060-009-0073-4 CrossRefPubMed

34.

Yamamoto M, Serizawa T, Shuto T et al (2014) Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol 15:387–395. https://doi.org/10.1016/s1470-2045(14)70061-0 CrossRefPubMed

35.

Rava P, Leonard K, Sioshansi S et al (2013) Survival among patients with 10 or more brain metastases treated with stereotactic radiosurgery. J Neurosurg 119:457–462. https://doi.org/10.3171/2013.4.JNS121751 CrossRefPubMed

36.

Chang EL, Wefel JS, Hess KR et al (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 10:1037–1044. https://doi.org/10.1016/s1470-2045(09)70263-3 CrossRefPubMed

37.

Wolf A, Kvint S, Chachoua A et al (2018) Toward the complete control of brain metastases using surveillance screening and stereotactic radiosurgery. J Neurosurg 128:23–31. https://doi.org/10.3171/2016.10.JNS161036 CrossRefPubMed

38.

Sperduto PW, Chao ST, Sneed PK et al (2010) Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys 77:655–661. https://doi.org/10.1016/j.ijrobp.2009.08.025 CrossRefPubMed

39.

Doin H, Nakamatsu K, Anami S et al (2019) Neutrophil-to-lymphocyte ratio predicts survival after whole-brain radiotherapy in non-small cell lung cancer. In Vivo 33:195–201. https://doi.org/10.21873/invivo.11459 CrossRef

40.

Coffelt SB, Wellenstein MD, de Visser KE (2016) Neutrophils in cancer: neutral no more. Nat Rev Cancer 16:431–446. https://doi.org/10.1038/nrc.2016.52 CrossRefPubMed

41.

Charles KA, Kulbe H, Soper R et al (2009) The tumor-promoting actions of TNF-alpha involve TNFR1 and IL-17 in ovarian cancer in mice and humans. J Clin Investig 119:3011–3023. https://doi.org/10.1172/JCI39065 CrossRefPubMedPubMedCentral

42.

Di Mitri D, Toso A, Chen JJ et al (2014) Tumour-infiltrating Gr-1+ myeloid cells antagonize senescence in cancer. Nature 515:134–137. https://doi.org/10.1038/nature13638 CrossRefPubMed

43.

Houghton AM, Rzymkiewicz DM, Ji H et al (2010) Neutrophil elastase-mediated degradation of IRS-1 accelerates lung tumor growth. Nat Med 16:219–223. https://doi.org/10.1038/nm.2084 CrossRefPubMedPubMedCentral

44.

Shojaei F, Wu X, Zhong C et al (2007) Bv8 regulates myeloid-cell-dependent tumour angiogenesis. Nature 450:825–831. https://doi.org/10.1038/nature06348 CrossRefPubMed

45.

Deryugina EI, Zajac E, Juncker-Jensen A, Kupriyanova TA, Welter L, Quigley JP (2014) Tissue-infiltrating neutrophils constitute the major in vivo source of angiogenesis-inducing MMP-9 in the tumor microenvironment. Neoplasia 16:771–788. https://doi.org/10.1016/j.neo.2014.08.013 CrossRefPubMedPubMedCentral

46.

Spicer JD, McDonald B, Cools-Lartigue JJ et al (2012) Neutrophils promote liver metastasis via Mac-1-mediated interactions with circulating tumor cells. Cancer Res 72:3919–3927. https://doi.org/10.1158/0008-5472.CAN-11-2393 CrossRefPubMed

47.

Cools-Lartigue J, Spicer J, McDonald B et al (2013) Neutrophil extracellular traps sequester circulating tumor cells and promote metastasis. J Clin Investig 123:3346–3458. https://doi.org/10.1172/JCI67484 CrossRef

48.

Martinez-Lostao L, Anel A, Pardo J (2015) How do cytotoxic lymphocytes kill cancer cells? Clin Cancer Res 21:5047–5056. https://doi.org/10.1158/1078-0432.CCR-15-0685 CrossRefPubMed

49.

Louveau A, Smirnov I, Keyes TJ et al (2015) Structural and functional features of central nervous system lymphatic vessels. Nature 523:337–341. https://doi.org/10.1038/nature14432 CrossRefPubMedPubMedCentral

50.

Neal MT, Chan MD, Lucas JT Jr et al (2014) Predictors of survival, neurologic death, local failure, and distant failure after gamma knife radiosurgery for melanoma brain metastases. World Neurosurg 82:1250–1255. https://doi.org/10.1016/j.wneu.2013.02.025 CrossRefPubMed

Titel: Pre-stereotactic radiosurgery neutrophil-to-lymphocyte ratio is a predictor of the prognosis for brain metastases
verfasst von: Lifeng Zhang
Yanjia Hu
Wei Chen
Yuan Tian
Yuebin Xie
Jing Chen
Publikationsdatum: 06.04.2020
Verlag: Springer US
Erschienen in: Journal of Neuro-Oncology / Ausgabe 3/2020
Print ISSN: 0167-594X
Elektronische ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-020-03477-w

Adult primary high-grade spinal glioma: a nationwide analysis of current trends in treatment and outcomes

Clinical Study

Incidence of second malignancies in individuals diagnosed with malignant peripheral nerve sheath tumors

Clinical Study

Epigenetic preconditioning with decitabine sensitizes glioblastoma to temozolomide via induction of MLH1

Open Access
Laboratory Investigation

End-of-life care for glioma patients; the caregivers’ perspective

Clinical Study

Intratumor injection of CCL21-coupled vault nanoparticles is associated with reduction in tumor volume in an in vivo model of glioma

Laboratory Investigation

Incidence of high grade gliomas presenting as radiographically non-enhancing lesions: experience in 111 surgically treated non-enhancing gliomas with tissue diagnosis

Clinical Study

Kompaktes Leitlinien-Wissen Neurologie (Link öffnet in neuem Fenster)

Mit medbee Pocketcards schnell und sicher entscheiden.
Leitlinien-Wissen kostenlos und immer griffbereit auf ihrem Desktop, Handy oder Tablet.

Kostenlos registrieren

Neu im Fachgebiet Neurologie

Einjährige Valaciclovir-Therapie schützt nicht vor Zoster-Rezidiv

24.03.2025
Herpes zoster
Nachrichten

Die Zoster Eye Disease Study (ZEDS) liefert gleich zwei ernüchternde Erkenntnisse: Eine einjährige Therapie mit niedrig dosiertem Valaciclovir kann weder einen Herpes zoster ophthalmicus (HZO) noch eine Post-Zoster-Neuralgie (PZN) verhindern.

MCI-Screening per Handy und Smartwatch? Könnte klappen

21.03.2025
Leichte neurokognitive Störung
Nachrichten

Handys und Smartwatches könnten niedrigschwellige Tools sein, um eine beginnende Demenz zu erfassen. In einer US-Studie ließ sich damit eine leichte kognitive Beeinträchtigung (MCI) gut nachweisen. Auch waren gerade die älteren Teilnehmenden sehr motiviert.

Welche MS-Subtypen gibt es?

18.03.2025
Multiple Sklerose
Nachrichten

Man kann Multiple Sklerose als ein Krankheitsspektrum sehen, in dem die Erkrankten unterschiedliche Phasen durchlaufen. Vielleicht gibt es aber auch klar definierbare Subtypen mit unterschiedlichen Verläufen. Auf der ACTRIMS-Tagung gab es dazu unterschiedliche Auffassungen.

Demenz-Leitlinie aktualisiert

13.03.2025
Demenz
Nachrichten

Empfohlen wird jetzt auch eine Musiktherapie sowie bei unklarem diagnostischem Befund ein Tau-PET, und Depressive mit leichten kognitiven Störungen sollten eine Verhaltenstherapie erhalten – das sind einige wichtige Änderungen der aktuellen S3-Leitlinie Demenzen.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Pre-stereotactic radiosurgery neutrophil-to-lymphocyte ratio is a predictor of the prognosis for brain metastases