Introduction: The Neutrophil-to-Lymphocyte Ratio (NLR) has been utilized to predict clinical outcomes in cardiovascular diseases, infectious diseases, and solid tumors and it has a potential association with the severity of Chronic Obstructive Pulmonary Disease (COPD). This study aimed to determine whether NLR is a possible predictor of inflammation severity and mortality in COPD. Methodology: A prospective analysis of NLR in 70 COPD patients, and its relation with biochemical, lung function parameters, and mortality was assessed. Results: NLR was negatively associated with oxygen saturation (p < 0.05) and positively related to C-reactive protein (CRP) (p < 0.05), matrix metalloproteinase-9 (MMP-9) (p ≤ 0.001), tissue inhibitor of metalloproteinase-1 (TIMP-1) (p < 0.05), MMP-9/TIMP-1 ratio (p < 0.05), and the modified Medical Research Council dyspnea scale (mMRC) score (p < 0.05). Deceased patients had significantly higher NLR (p < 0.05). Older age and lower levels of saturation were independently associated with higher mortality in COPD patients (p < 0.05). Conclusions: NLR in COPD correlates with inflammation and protease/antiprotease balance, with elevated NLR detected in deceased patients. These findings suggest that NLR can be a helpful clinical marker in COPD.

Background: Although immune checkpoint inhibitors (ICI) have revolutionized the treatment landscape for patients with non-small cell lung cancer (NSCLC), the impact on brain metastases (BM) remains uncertain, as these patients have often been excluded from or underrepresented in clinical trials. The aim of this study was to investigate the association between metastatic site and response to immunotherapy.Methods: This retrospective single-center study included 141 consecutive adults with advanced NSCLC, programmed death ligand 1 (PD-L1) tumor proportion score ≥50%, Eastern Cooperative Oncology Group (ECOG) performance status 0–1, and no activating epidermal growth factor receptor (EGFR) mutation or anaplastic lymphoma kinase (ALK) rearrangement who received first-line pembrolizumab monotherapy between 2018 and 2022. Patients with BM received stereotactic radiosurgery or whole-brain radiotherapy before or in parallel with pembrolizumab according to multidisciplinary recommendations. Survival was analyzed using Kaplan-Meier estimates, log-rank testing, and Cox proportional hazards models. Because metastatic-site coding was available only for patients with documented distant metastases, the site-specific BM versus other metastatic site comparison was restricted to a 115-patient subset.Results: The full cohort comprised 141 analyzable patients. In the primary metastatic-site subset (n = 115), 28 patients had BM and 87 had other metastatic sites without BM. In this subset, progression-free survival (PFS) was longer in the BM group than in the non-BM metastatic-site group (hazard ratio [HR] 0.42, (95% CI 0.19–0.94; p = 0.035)). Median PFS was not reached in the BM group (95% CI 14.0 months to not reached) and was 26.0 months (95% CI 8.0 months to not reached) in the non-BM group. Overall survival (OS) did not differ significantly (HR 0.48, 95% CI 0.21–1.09; p = 0.080); the median OS was not reached in the BM group (95% CI 14.0 months to not reached) and was 30.0 months (95% CI 15.0–40.0 months) in the non-BM group.Conclusion: In this retrospective cohort, patients with BM who received pembrolizumab plus local CNS-directed radiotherapy had longer PFS than patients with other metastatic sites, but no statistically significant OS advantage. These findings should be interpreted cautiously because all BM patients received local radiotherapy and had lower extracranial metastatic burden; the observed PFS difference may reflect treatment-related confounding, selection bias, and baseline prognostic imbalance rather than intrinsic sensitivity of brain metastases to immunotherapy.

Background: Low-dose computed tomography (LDCT) lung cancer screening (LCS) frequently identifies emphysema in high-risk smokers. However, the extent to which CT-detected emphysema reflects underlying physiological impairment remains uncertain. We evaluated whether spirometry can detect functional abnormalities in this population beyond structural imaging findings. Methods: This cross-sectional study included 323 individuals with LDCT- detected emphysema and no lung cancer or prior chronic respiratory diseases within a screening cohort (n = 3076). Participants underwent pre-bronchodilator spirometry and symptom assessments (COPD Assessment test (CAT) and Modified Medical Research Council (mMRC) Dyspnea Scale). Pre-bronchodilator airflow limitation was defined as forced expiratory volume in one second to forced vital capacity ratio (FEV₁/FVC) < 0.70. Small airways dysfunction was defined by ≥2 reduced mid-expiratory flow parameters (<60% predicted). Flow–volume curve morphology was assessed qualitatively. Results: Pre-bronchodilator airflow limitation was observed in 45.2% of participants, predominantly mild. Small-airway dysfunction was present in 52%, and an abnormal flow–volume curve morphology in 67.5%. Notably, functional abnormalities were frequently observed despite preserved FEV₁. Symptom burden was low, with only 7.7% of participants reporting clinically significant symptoms. Functional impairments often overlapped and were common in minimally symptomatic individuals. Conclusions: In a lung cancer screening (LCS) cohort with CT-detected emphysema, functional abnormalities are frequently observed, including in individuals with preserved FEV₁ and minimal symptoms. Spirometry provides additional physiological insight beyond structural imaging; however, these findings are descriptive and should not be interpreted as diagnostic of COPD. Further studies are needed to determine their clinical relevance.