Systemic inflammation scores correlate with survival prognosis in patients with newly diagnosed brain metastases

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; p_adj < 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; p_adj = 1.62e - 13₎, NLR (HR 1.55; 95% CI: 1.38-1.75; p_adj = 1.92e - 11), LLR (HR 1.57; 95% CI: 1.39-1.77; p_adj = 1.96e - 11₎, PLR (HR 1.60; 95% CI: 1.39-1.85; p_adj = 2.87955e - 9), MLR (HR 1.41; 95% CI: 1.14-1.75; p_adj = 0.027) and CRP/Alb (HR 1.83; 95% CI: 1.54-2.18; p_adj = 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.