Systemic inflammation measured by the neutrophil-to-lymphocyte ratio (NLR), leucocyte-to-lymphocyte ratio (LLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR) and CRP/albumin ratio (CRP/Alb) was shown to impact the survival prognosis in patients with extracranial solid cancer.
One thousand two hundred and fifty patients with newly diagnosed brain metastases (BM) were identified from the Vienna Brain Metastasis Registry.
PLR and CRP/Alb were higher in patients with progressive extracranial disease and lower in patients with no evidence of extracranial disease. Lower NLR (cut-off = 5.07; 9.3 vs. 5.0 months), LLR (cut-off = 5.76; 10.0 vs. 5.3 months), PLR (cut-off = 335; 8.0 vs. 3.8 months), MLR (cut-off = 0.53; 6.0 vs. 3.5 months) and CRP/Alb (cut-off = 2.93; 8.5 vs. 3.7 months; padj < 0.05) were associated with longer overall survival (OS). In multivariate analysis with graded prognostic assessment (hazard ratio (HR) 1.45; 95% confidence interval (CI): 1.32–1.59; padj = 1.62e − 13), NLR (HR 1.55; 95% CI: 1.38–1.75; padj = 1.92e − 11), LLR (HR 1.57; 95% CI: 1.39–1.77; padj = 1.96e − 11), PLR (HR 1.60; 95% CI: 1.39–1.85; padj = 2.87955e − 9), MLR (HR 1.41; 95% CI: 1.14–1.75; padj = 0.027) and CRP/Alb (HR 1.83; 95% CI: 1.54–2.18; padj = 2.73e − 10) remained independent factors associated with OS at BM diagnosis.
Systemic inflammation, measured by NLR, LLR, PLR, MLR and CRP/Alb, was associated with OS in patients with BM. Further exploration of immune modulating therapies is warranted in the setting of BM.
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We sincerely thank Felix Haupolter for his help in data acquisition. This study was performed within the Ph.D. thesis of Angelika M. Starzer with the title “Immune monitoring in cancer patients” in the N790 doctoral programme at the Medical University of Vienna, Austria. The content of this manuscript was partly presented at the Brain Metastasis Research Symposium in Vienna, Austria, in June 2019 and at the annual conference of the European Society for Medical Oncology (ESMO) in Barcelona, Spain, in September 2019 and nominated as best poster in the CNS session.
Ethics approval and consent to participate
This study was approved by the ethics committee of the Medical University of Vienna (Vote EK 078/2004). Due to the retrospective design of the study the ethics board waived the informed consent of individual patients. This study was performed in accordance with the Declaration of Helsinki.
The data supporting the results in this manuscript is saved at a server of the Medical University of Vienna.
A.M.S. has received travel support from PharmaMar. A.S.B. has research support from Daiichi Sankyo and Roche, honoraria for lectures, consultation or advisory board participation from Roche, Bristol-Meyers Squibb, Merck, Daiichi Sankyo as well as travel support from Roche, Amgen, Daiichi Sankyo and AbbVie. M.P. has received honoraria for lectures, consultation or advisory board participation from the following for-profit companies: Bayer, Bristol-Myers Squibb, Novartis, Gerson Lehrman Group (GLG), CMC Contrast, GlaxoSmithKline, Mundipharma, Roche, BMJ Journals, MedMedia, Astra Zeneca, AbbVie, Lilly, Medahead, Daiichi Sankyo, Sanofi, Merck Sharp & Dome, Tocagen. The following for-profit companies have supported clinical trials and contracted research conducted by M.P. with payments made to his institution: Böhringer-Ingelheim, Bristol-Myers Squibb, Roche, Daiichi Sankyo, Merck Sharp & Dome, Novocure, GlaxoSmithKline, AbbVie. G.H. has received research support from Bristol-Meyers Squibb and Merck. All other authors report no conflicts of interest concerning this specific publication.
The study costs were supported by a grant from the Margaretha Hehberger-Stiftung assigned to A.S.B. (Project 18085; title: Impact of local and systemic treatments on the inflammatory microenvironment composition in brain metastases). The funding source supported this study by partly financing a Ph.D. student.
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Starzer, A.M., Steindl, A., Mair, M.J. et al. Systemic inflammation scores correlate with survival prognosis in patients with newly diagnosed brain metastases. Br J Cancer (2021). https://doi.org/10.1038/s41416-020-01254-0