Clinical Study On The Prognostic Value Of Pre- Concurrent Radiochemotherapy Neutrophil Lymphocyte Ratio And Platelet Lymphocyte Ratio For Brain Metastasis In Stage Ⅲ Initial Treatment Lung Adenocarcinoma Patients

Background and Purpose: Studies have shown that the presence of systematic inflammation correlates with survival in various cancers.The increased neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)markers of systemic inflammation is a poor prognostic factor for non-small cell lung cancer(NSCLC).Higher NLR values were associated with occurrence of brain metastases.The purpose of this study was to evaluate the predictive value of pretreatment NLR and PLR for brain metastasis in patients with stage III initial treatment lung adenocarcinoma undergoing concurrent chemoradiation.Patients and methods: We performed a retrospective analysis of 120 patients with stage III initial treatment lung adenocarcinoma undergoing concurrent chemoradiation between January 2013 and December 2016.According to whether occurred brain metastases after treatment,patients were divided into brain metastasis group and without brain metastasis group.All patients received routine radiotherapy with a total dose of 40-75 Gy.The chemotherapy protocol was platinum-based chemotherapy.The clinical features blood test results with in 2-5 days before treatment.Tumor stage and treatment plan of the two groups were collected.The NLR and PLR were calculated based on the absolute neutrophil count,the absolute lymphocyte count,and the absolute platelet count of the before the treatment.According to the ROC curve,the cutoff value of NLR was taken as 3.3,and the median valueof PLR,neutrophils,platelets and lymphocytes was taken as the cutoff value.According to the TNM stage,the clinical stage of patients is divided into IIIA and IIIB stages.The effects of various factors on the prognosis of brain metastases were compared.Kaplan-Meier survival curves were used to analyze the prognostic role of NLR,PLR,TNM staging,gender,age,neutrophil absolute value,lymphocyte absolute count,platelet absolute count for brain metastases.Univariate and multivariate analysis were performed using the Cox’s proportional hazards regression model.When significant differences were found in the univariate analysis(P<0.05),this factor was gradually included in the multivariate analysis.The follow-up time was up to the patient’s brain metastases.Patients with no brain metastases were followed up until August 2017.Results: A total of 120 patients were included in the study.There were 45 cases in brain metastasis group and 75 cases without brain metastasis group.There were 29 patients with high NLR(≥3.3),91 patients with low NLR(<3.3),62 patients with high PLR(≥135),and 58 patients with low PLR(<135).The clinical stage was 53 cases in stage IIIA and 67 cases in stage IIIB.Kaplan-Meier survival analysis showed that TNM staging,NLR was associated with brain metastases,and brain metastases were more likely to occur in stage IIIB than in stage IIIA(p=0.035)and in the high NLR group than in the low NLR group(p=0.009).PLR(p=0.207)and other factors had no effect on brain metastases.Multivariate analysis using the Cox’s proportional hazards regression model showed that tumor stage and NLR were significantly associated with brain metastases(P=0.014;P=0.003),and were independent prognostic factors for brain metastases.Conclusion: For patients with stage III initial treatment lung adenocarcinoma undergoing concurrent chemoradiation patients,high NLR is more prone to brain metastases than low NLR and stage IIIB is more likely to occur brain metastases than IIIA.Pretreatment PLR and other prognostic risk factors had no effect on brain metastases.