Distant Brain Failure and Subsequent Survival After Gamma Knife Radiosurgery for Breast Cancer Brain Metastases: Prognostic Value of Pretreatment Inflammatory Markers.

Authors

Sijun Diao, Fujun Liu, Zhongyu Li, Shihong Zhu, Xiyue Lu, Huiyang Luo, Jing Chen

Published in

Journal of clinical medicine. Volume 15. Issue 21. Nov 07, 2026. Epub Nov 07, 2026.

Abstract

Background/Objectives: Whether pretreatment inflammatory markers inform both the risk of distant brain failure (DBF) and survival after its occurrence remains unclear in breast cancer brain metastases. We evaluated these associations across the clinical course following Gamma Knife radiosurgery (GKRS). Methods: This retrospective cohort included 91 women undergoing initial GKRS. Four blood-derived inflammatory markers were analyzed separately as standardized log₂-transformed variables. Fine-Gray models evaluated first DBF with death as a competing event. Multistate and transition-specific Cox analyses distinguished mortality before and after DBF. Marker comparisons underwent Benjamini-Hochberg false-discovery-rate correction. Results: DBF developed in 57 patients, of whom 36 subsequently died; 16 patients died before DBF. Cumulative DBF incidence reached 41.8% at 12 months and 61.0% at 24 months. A higher pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio were associated with first DBF (adjusted subdistribution hazard ratios per standard-deviation increase: 1.52, 95% confidence interval [CI] 1.09-2.10; and 1.38, 95% CI 1.04-1.83, respectively; both q = 0.047). Median survival after DBF was 10.5 months. NLR measured before initial GKRS remained associated with post-DBF mortality after adjustment for age, performance status at DBF, and extracranial disease progression at DBF (hazard ratio, 2.29; 95% CI, 1.45-3.61; q = 0.003). With a time-varying performance-status coefficient, the NLR hazard ratio was 2.75 (95% CI, 1.68-4.51; nominal p < 0.001). No inflammatory marker was significantly associated with mortality before DBF after adjustment for multiple testing. Conclusions: Pretreatment NLR was associated with both first DBF and subsequent mortality, whereas PLR was associated with first DBF. The predominantly HER2-positive cohort (68.1%) limits generalizability. Further validation is needed to establish the predictive and clinical value of these associations.

PMID:
43030843
Bibliographic data and abstract were imported from PubMed on 14 Nov 2026.

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