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CC BY-NC-ND 4.0 · Avicenna J Med 2022; 12(02): 067-072
DOI: 10.1055/s-0042-1749613
Original Article

The Predictive Value of Peripheral Immune Cell Counts for the Presence of Brain Metastases in Stage IV Non-Small-Cell Lung Cancer (NSCLC)

I Abuelbeh
1   Department of General Surgery, Manchester Royal Infirmary, Manchester, United Kingdom
,
O Abu-Shawer
2   Department of Internal Medicine, Cleveland Clinic, Cleveland, United States
,
M Abu-Shawer
3   Department of Internal Medicine, Istiklal Hospital, Amman, Jordan
,
M Alkderat
4   University of Jordan School of Medicine, Amman, Jordan
,
M Safi
5   Department of General Surgery, Barnsley Hospital, Barnsley, United Kingdom
,
A Alwazani
6   University of Jordan School of Medicine, Amman, Jordan
,
A Alkhatib 
7   Department of Surgery, King Hussein Cancer Center, Amman, Jordan
,
B Abu-Hussain 
8   University of Jordan School of Medicine, Amman, Jordan
,
M Aladawi
9   Department of Neurological Sciences, University of Nebraska, Omaha, United States
,
S Ismail
10   University of Jordan School of Medicine, Amman, Jordan
,
T Altamimi
11   Department of Internal Medicine, Rochester General Hospital, New York, United States
,
Taher Abu Hejleh
12   Department of Internal Medicine, Division of Hematology, Oncology and Blood and Marrow Transplantation, University of Iowa Carver College of Medicine, Iowa City, Iowa
13   Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
› Author Affiliations Funding None.
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Abstract

Background High neutrophil–lymphocyte ratio (NLR) is associated with poor survival in lung cancer. This study evaluates whether NLR is associated with baseline brain metastasis in stage IV non-small cell lung cancer (NSCLC).

Methods Medical records of stage IV NSCLC patients treated at King Hussein Cancer Center (Amman-Jordan) between 2006 and 2016 were reviewed. Patients with baseline brain imaging and complete blood count (CBC) were included. Receiver operating characteristic (ROC) curve was used to identify the optimal cutoff value for the association between NLR and baseline brain metastasis. Association between age, gender, location of the primary tumor, histology, and NLR was assessed using univariate and multivariate logistic regression analyses.

Results A total of 722 stage IV NSCLC patients who had baseline brain imaging were included. Median age was 59 years. Baseline brain metastasis was present in 280 patients (39.3%). Nine patients had inconclusive findings about brain metastasis. The ROC curve value of 4.3 was the best fitting cutoff value for NLR association with baseline brain metastasis. NLR ≥ 4.3 was present in 340 patients (48%). The multivariate analyses showed that high baseline NLR (≥ 4.3) was significantly associated with higher odds of baseline brain metastasis (odds ratio [OR]: 1.6, 95% confidence interval [CI]: 1.2–2.2; p = 0.0042). Adenocarcinoma histology was also associated with baseline brain metastasis (OR: 0.4, 95% CI: 0.25–0.6; p = 0.001).

Conclusion High NLR is associated with baseline brain metastasis in advanced-stage NSCLC. In the era of immunotherapy and targeted therapies, whether high NLR predicts response of brain metastasis to treatment is unknown.

Keywords

NSCLC - neutrophil–lymphocyte ratio - brain metastasis - stage IV


Publication History

Article published online:
03 July 2022

© 2022. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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