免疫检查点抑制剂（ICIs）治疗已显示出对多种癌症类型的临床益处。据报道，中性粒细胞与淋巴细胞比率 (NLR) 与接受 ICI 治疗的患者的生存时间或无进展生存期相关。然而，尚未对接受立体定向放射外科 (SRS) 联合 ICI 的脑转移 (BM) 患者进行 NLR 评估。作者调查了 NLR 对接受 SRS 并发 ICI 的 BM 患者生存数据的预测影响。对 2015 年 1 月至 2023 年 8 月期间接受 SRS 并发 ICI 的 BM 患者的临床记录进行回顾性分析。 NLR 是使用 SRS 之前最后一次检查获得的数据计算的。通过对事件发生时间数据（总生存期 [OS] ≤ 18 个月）的受试者工作特征 (ROC) 曲线分析确定最佳 NLR 截止值。比较两个 NLR 组之间的 OS 和颅内疾病无进展生存 (IC-PFS) 率。在 185 名符合条件的患者中，132 名是男性。患者中位年龄 (IQR) 为 69 (61-75) 岁。原发癌为肺癌、泌尿生殖系统癌、皮肤癌、乳腺癌、胃肠道癌等，分别有 132 例、23 例、22 例、2 例、2 例、4 例。整个队列的 SRS 后中位 OS 和 IC-PFS 时间分别为 18.4 (95% CI 14.0-23.1) 个月和 9.2 (95% CI 6.9-10.8) 个月。 ROC 曲线分析确定 18 个月 OS 的最佳 NLR 截止值为 5.0（曲线下面积 0.64，Youden 指数 0.31）。 Kaplan-Meier 分析显示，NLR 高（> 5）的患者 OS 显着缩短（48 名患者的中位生存时间为 10.9 个月，137 名患者的中位生存时间为 22.2 个月，HR 2.0，95% CI 1.3-3.0，p < 0.001）。同样，中位 IC-PFS 也存在显着差异：高 NLR 为 4.8 个月，而低 NLR 为 10.7 个月（HR 1.7，95% CI 1.2-2.5，p = 0.003）。作者发现 SRS 前 NLR 升高（> 5) SRS 后与同时进行 BM ICI 的较短 OS 和 IC-PFS 相关。 NLR 是一种简单、经济有效且广泛使用的生物标志物，因此可用于管理同时接受 SRS 和 ICI 的 BM 患者。然而，需要对其他大型数据集进行进一步调查来验证这些发现。

Treatment with immune checkpoint inhibitors (ICIs) has shown clinical benefit for a wide range of cancer types. The neutrophil-to-lymphocyte ratio (NLR) reportedly correlates with survival time or progression-free survival in patients treated with ICIs. However, NLR has not yet been assessed in patients with brain metastases (BMs) receiving stereotactic radiosurgery (SRS) combined with concurrent ICIs. The authors investigated the predictive impact of NLR on the survival data of patients with BMs who received SRS with concurrent ICIs.The clinical records of patients who had undergone SRS with concurrent ICIs for BMs between January 2015 and August 2023 were retrospectively analyzed. NLR was calculated using the data obtained from the last examination prior to SRS. The optimal NLR cutoff value was identified by receiver operating characteristic (ROC) curve analysis for time-to-event data (overall survival [OS] ≤ 18 months). OS and intracranial disease progression-free survival (IC-PFS) rates were compared between the two NLR groups.Of the 185 eligible patients included, 132 were male. The median (IQR) patient age was 69 (61-75) years. The primary cancers were lung, genitourinary, skin, breast, gastrointestinal, and others in 132, 23, 22, 2, 2, and 4 patients, respectively. The post-SRS median OS and IC-PFS times for the entire cohort were 18.4 (95% CI 14.0-23.1) months and 9.2 (95% CI 6.9-10.8) months, respectively. ROC curve analysis identified the optimal NLR cutoff value for 18-month OS to be 5.0 (area under the curve 0.64, Youden index 0.31). Kaplan-Meier analysis revealed that patients with high NLR (> 5) had a significantly shorter OS (median survival time 10.9 months for 48 patients vs 22.2 months for 137 patients, HR 2.0, 95% CI 1.3-3.0, p < 0.001). Similarly, a significant difference in median IC-PFS was noted: 4.8 months with high NLR versus 10.7 months with low NLR (HR 1.7, 95% CI 1.2-2.5, p = 0.003).The authors found elevated pre-SRS NLR (> 5) to be associated with shorter OS and IC-PFS after SRS with concurrent ICIs for BMs. NLR is a simple, cost-effective, and widely accessible biomarker, which can thus be used for managing patients with BMs receiving SRS concurrently with ICIs. Further investigation in other large datasets is, however, required to validate these findings.