Effect Of Coagulation And Immunity Index On The Prognosis Of Non-small Cell Lung Cancer Patients With Brain Metastases After SRS

Objectives To explore the effect of D-dimer,fibrinogen and peripheral blood lymphocyte subsets CD4~+/CD8~+ratio on the prognosis of non-small cell lung cancer(NSCLC)patients with brain metastases(BM)who underwent stereotactic radiotherapy(SRS).Methods 1 The retrospective study was performed including 132 NSCLC-BM patients who received gamma knife treatment in Hebei General Hospital from January 2018 to December 2020.The cutoff value of D-dimer and fibrinogen was determined by the receiver operating characteristic(ROC)curve,and these patients were grouped for further analysis according to the thresholds.The prognostic significance of D-dimer and fibrinogen was evaluated by the Log rank test and Cox proportional hazards model.2 The retrospective study included 80 NSCLC patients with brain metastases who received gamma knife treatment in Hebei General Hospital from January 2018 to December 2020.The cutoff value of CD4~+/CD8~+ratio was determined by the receiver ROC curve,and these patients were grouped for further analysis according to the thresholds.The prognostic significance of CD4~+/CD8~+ratio was evaluated by the Log rank test and Cox proportional hazards model.Results 1 The median intracranial progression-free survival(i PFS)of 132 NSCLC-BM patients was 8 months and the median overall survival(OS)was 15 months.The survival curve revealed that the 6-month,1-year and 2-year i PFS rates in D-dimer<0.52mg/L and≥0.52mg/L groups,fibrinogen<3.30g/L and≥3.30g/L groups were significantly different(P<0.05).In addition,there were significant differences in the 6-month,1-year and 2-year OS rates in D-dimer<0.52mg/L and≥0.52mg/L groups,fibrinogen<3.04g/L and≥3.04g/L groups(P<0.05).Factors significantly associated with i PFS and OS in univariate analysis were cumulative intracranial tumour volume and D-dimer(both P<0.05).Furthermore,extracranial metastases(P=0.001)and fibrinogen(P=0.011)were independently correlated with OS.Multivariate analysis showed that cumulative intracranial tumour volume(29)6.5cm~3(P=0.012)and D-dimer≥0.52mg/L(P=0.002)were significant unfavorable factors,while presence of extracranial metastases(P=0.005),cumulative intracranial tumour volume(29)6.5cm~3(P=0.001)and D-dimer≥0.52mg/L(P=0.001)were independent risk factors affecting OS after SRS.2 The median i PFS of80 NSCLC-BM patients was 8 months and the median OS was 20 months.The survival curve revealed that the i PFS rates at the 6-month,1-year and 2-year period in CD4~+/CD8~+ratio(27)1.73 and≥1.73 groups were significantly different(P(27)0.05).In addition,there were significant differences in the 6-month,1-year and 2-year OS rates in CD4~+/CD8~+ratio(27)1.51 and≥1.51 groups(P<0.05).Univariate analysis showed that cumulative intracranial tumour volume,treatment option and CD4~+/CD8~+ratio(all P<0.05)were closely related to i PFS,while extracranial metastases,number of brain metastases,cumulative intracranial tumour volume and CD4~+/CD8~+ratio(all P<0.05)were closely related to OS.On multivariable analysis,cumulative intracranial tumour volume(29)6.5cm~3(P=0.016),SRS alone(P=0.010)and CD4~+/CD8~+ratio<1.73(P=0.015)were independent risk factors for i PFS,while cumulative intracranial tumour volume(29)6.5cm~3(P=0.013),presence of extracranial metastases(P=0.023)and CD4~+/CD8~+ratio<1.51(P=0.007)were for OS.Conclusions Pre-treatment cumulative intracranial tumour volume(29)6.5cm~3,high D-dimer or low CD4~+/CD8~+ratio could be used as independent risk indicators for i PFS and OS of NSCLC patients with brain metastases after SRS,while extracranial metastases could be independently correlated with OS.Figure5;Table12;Reference148...