The predictive value of pre-radiosurgery leucocyte-based prognostic ratios was investigated in a selected cohort of non-small cell lung cancer patients (NSCLC) patients with radiosurgically treated brain metastases (BM) and concomitant immunotherapy (IT) or targeted therapy (TT).
We performed a retrospective analysis of 166 NSCLC BM patients treated with Gamma Knife Radiosurgery. The Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Lymphocyte-to-Monocyte Ratio (LMR) were assessed within 14 days prior to radiosurgical treatment.
In radiosurgically treated NSCLC BM patients with concomitant IT or TT, the estimated median survival after GKRS1 was significantly longer in patients with a NLR cut-off value <5 (p=0.038). Consequently, the Cox regression model for NLR cut-off value groups revealed a significant hazard ratio (HR) of 1.519 (95%CI=1.020-2.265; p=0.040). In addition, each increase in the NLR of 1 equaled an increase of 5.4% in risk of death (HR 1.054; 95%CI=1.024-1.085; p<0.001). After adjusting for sex, age, Karnofsky Performance Status Scale, and presence of extracranial metastases, the NLR remained a significant and independent predictor for survival (HR 1.047; 95%CI=1.017-1.078; p=0.002). In contrast, PLR and LMR did not exhibit the same predictive value among our selected cohort of radiosurgically treated BM patients with IT or TT.
In NSCLC BM patients, treated with IT or TT, pre-radiosurgical NLR represents a simple prognostic predictor for survival and is superior to other leucocyte-based ratios. Thus, especially NLR may be relevant for clinical decision making, therapeutic evaluation, patient counselling, and appropriate stratification of future clinical trials among radiosurgically treated BM patients.

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