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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(09): 922-928
DOI: 10.1055/s-0042-1755324
Original Article

The preoperative neutrophil-to-lymphocyte ratio predictive value for survival in patients with brain metastasis

O valor do índice neutrófilo-linfócito como preditor de sobrevida em pacientes com metástases cerebrais
Helder Picarelli 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Divisão de Neurocirurgia, São Paulo SP, Brazil.
2   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto do Câncer de São Paulo, São Paulo SP, Brazil.
,
Vitor Nagai Yamaki 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Divisão de Neurocirurgia, São Paulo SP, Brazil.
,
Davi Jorge Fontoura Solla 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Divisão de Neurocirurgia, São Paulo SP, Brazil.
,
Iuri Santana Neville 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Divisão de Neurocirurgia, São Paulo SP, Brazil.
2   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto do Câncer de São Paulo, São Paulo SP, Brazil.
,
Alexandra Gomes dos Santos 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Divisão de Neurocirurgia, São Paulo SP, Brazil.
,
Bruno Spindola Amaral Garcia de Freitas 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Divisão de Neurocirurgia, São Paulo SP, Brazil.
,
Calvin Diep 
3   University of Toronto Medical School, Department of Anesthesiology and Pain Medicine, Toronto, Ontario, Canada.
,
Wellingson Silva Paiva 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Divisão de Neurocirurgia, São Paulo SP, Brazil.
,
Manoel Jacobsen Teixeira 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Divisão de Neurocirurgia, São Paulo SP, Brazil.
,
Eberval Gadelha Figueiredo 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Divisão de Neurocirurgia, São Paulo SP, Brazil.
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Abstract

Background The neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte ratio (PLR), and red blood cell distribution width (RDW) have been previously studied as predictors of survival in different malignancies.

Objective The aim of this study was to evaluate the predictive value of these hematologic inflammatory biomarkers for patients with brain metastases (BM).

Methods We reviewed a consecutive cohort of patients at Instituto do Cancer do Estado de São Paulo (ICESP-FMUSP) from 2011 to 2016 with ≥ 1 BM treated primarily by surgical resection. The primary outcome was 1-year survival. We optimized the NLR, MLR, PLR, and RDW cutoff values, preserving robustness and avoiding overestimation of effect size.

Results A total of 200 patients (mean age 56.1 years; 55.0% female) met inclusion criteria. Gross-total resection was achieved in 89.0%. The median (quartiles) preoperative and postoperative KPS scores were 60 (50–80) and 80 (60–90), respectively. Preoperative NLR was significantly associated with survival (HR 2.66, 95% CI: 1.17–6.01, p = 0.019). A NLR cutoff value of 3.83 displayed the most significant survival curve split.

Conclusions Preoperative NLR is an independent predictor of survival in newly diagnosed BM. We propose a cutoff value of 3.83 for preoperative NLR testing may be clinically useful as predictor of poor survival in this population. The wide accessibility of the NLR favors its inclusion in clinical decision-making processes for BM management.

Resumo

Antecedentes Os neutrófilos para linfócitos (NLR), monócitos para linfócitos (MLR), proporção de plaquetas para linfócitos (PLR) e largura de distribuição de glóbulos vermelhos (RDW) foram previamente estudados como preditores de sobrevivência em diferentes malignidades.

Objetivo O objetivo deste estudo foi avaliar o valor preditivo desses biomarcadores inflamatórios hematológicos para pacientes com metástases cerebrais (MB).

Métodos Nós revisamos uma coorte consecutiva de pacientes no Instituto do Câncer do Estado de São Paulo (ICESP-FMUSP) de 2011 a 2016 com ≥ 1 MB tratados principalmente por ressecção cirúrgica. O desfecho primário foi a sobrevida em 1 ano. Otimizamos os valores de corte de NLR, MLR, PLR e RDW, preservando a robustez e evitando superestimação do tamanho do efeito.

Resultados Um total de 200 pacientes (idade média de 56,1 anos; 55,0% mulheres) preencheram os critérios de inclusão. A ressecção grosseira total foi obtida em 89,0%. A mediana (quartis) dos escores KPS pré-operatório e pós-operatório foram 60 (50–80) e 80 (60–90), respectivamente. O NLR pré-operatório foi significativamente associado à sobrevida (HR 2,66, IC 95%: 1,17–6,01, p = 0,019). Um valor de corte de NLR de 3,83 exibiu a divisão da curva de sobrevivência mais significativa.

Conclusões O NLR pré-operatório é um preditor independente de sobrevida em MBs recém-diagnosticados. Propomos que um valor de corte de 3,83 para o teste de NLR pré-operatório pode ser clinicamente útil como preditor de baixa sobrevida nesta população. A ampla acessibilidade do NLR favorece sua inclusão nos processos de tomada de decisão clínica para o gerenciamento de BM.

Keywords

Brain Neoplasms - Survival Analysis - Biomarkers

Palavras-chave

Neoplasias Encefálicas - Análise de Sobrevida - Biomarcadores

Authors' Contributions

HP, IN, VY, DS, MT, EF, WP: conception and design; HP: patients' recruitment; HP, IN, AS, VY, BF: data collection; VY, AS, DS: data analysis and interpretation; HP, VY, IN, AS: drafting the manuscript for important intellectual content; HP, IN, VY, DS, AS, CD, MT, EF, WP: text review. All authors contributed to the article and approved the submitted version.




Publication History

Received: 08 September 2021

Accepted: 01 February 2022

Article published online:
04 October 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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