5119 - Markers of systemic inflammation correlate with survival prognosis in patients with newly diagnosed brain metastases

Background

Cancer - immune system interactions are currently in focus of oncology research as immune modulating therapies have shown remarkable activity, also in patients with brain metastases (BM). Therefore, we aimed to investigate markers of systemic inflammation and their impact on survival prognosis in a large real-life cohort of BM patients.

Methods

1250 patients with newly diagnosed BM were identified from the Vienna Brain Metastasis Registry. Systemic inflammation markers included: neutrophil-to-lymphocyte ratio (NLR), leucocyte/lymphocyte ratio (LLR), platelet/lymphocyte ratio (PLR), CRP/Albumin ratio (CRP/Alb). Median was chosen as a cut-off value.

Results

Low NLR was associated with statistically significantly longer OS compared to high NLR (9 vs. 5 months; p < 0.001; log rank). Low CRP/Alb was further associated with improved prognosis as patients with low CRP/Alb presented with a median OS of 8 compared to 4 months in patients with high CRP/Alb (p < 0.001; log rank). Low LLR and PLR were also associated with a favorable survival prognosis (p < 0.001; log rank). NLR and LLR did not show differences depending on the stage of the primary tumor at diagnosis of BM (p > 0.05; Kruskal-Wallis). CRP/Alb was highest in patients with progressive disease, followed by patients with diagnosis of BM simultaneously with primary cancer diagnosis and lowest in patients with stable disease (p = 0.004; Kruskal-Wallis). PLR was highest in patients with progressive disease, followed by patients with stable disease and lowest in patients with BM diagnosis at primary cancer diagnosis (p = 0.02; Kruskal-Wallis). In multivariate analysis with DS-GPA, NLR (HR 1.40; 95% CI:1.2-1.6; p < 0.001; cox regression model), LLR (HR 1.43; 95% CI:1.3-1.6; p < 0.001; cox regression model), CRP/Alb (HR 1.48; 95% CI:1.2-1.8; p < 0.001; cox regression model) and PLR (HR 1.23; 95% CI:1.1-1.4; p = 0.001; cox regression model) remained independent factors associated with survival prognosis after BM diagnosis.

Conclusions

Markers of systemic inflammation including NLR, LLR, CRP/Alb and PLR were associated with survival prognosis of newly diagnosed BM patients underscoring the importance of cancer – immune system interactions in patients with CNS metastatic disease.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

M. Preusser: Research grant / Funding (self): Böhringer-Ingelheim; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self): GlaxoSmithKline; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self): Merck Sharp & Dome; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self): Roche; Honoraria (self), Advisory / Consultancy: Bristol-Myers Squibb; Honoraria (self), Advisory / Consultancy: Novartis; Honoraria (self), Advisory / Consultancy: Gerson Lehrman Group; Honoraria (self), Advisory / Consultancy: CMC Contrast; Honoraria (self), Advisory / Consultancy: Mundipharma; Honoraria (self), Advisory / Consultancy: AstraZeneca; Honoraria (self), Advisory / Consultancy: AbbVie; Honoraria (self), Advisory / Consultancy: Lilly; Honoraria (self), Advisory / Consultancy: Medahead; Honoraria (self), Advisory / Consultancy: Daiichi Sankyo. A.S. Berghoff: Honoraria (self), Advisory / Consultancy, Research grant / Funding (self): Daiichi Sankyo; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self), Travel / Accommodation / Expenses: Roche; Honoraria (self), Advisory / Consultancy: Bristol-Meyers Squibb; Honoraria (self), Advisory / Consultancy: Merck; Travel / Accommodation / Expenses: Amgen; Travel / Accommodation / Expenses: AbbVie. All other authors have declared no conflicts of interest.