Recent studies suggest that inflammation response biomarkers are prognostic indicators of solid tumor outcomes. Here, we quantify the prognostic value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) in glioblastomas (GBMs), taking into consideration the role of the isocitrate dehydrogenase (IDH) mutation status. We examined 141 primary glioblastomas (pGBMs) and 25 secondary glioblastomas (sGBMs). NLRs, PLRs, and LMRs were calculated before surgery. IDH mutations were detected immunohistochemically after tumor resection, and patients' clinical outcomes were analyzed after classification into GBM, pGBM, and IDH-wild type glioblastoma (IDH-wt GBM) groups. To make comparisons, we set cutoffs for NLR, PLR and LMR of 4.0, 175.0, and 3.7, respectively. In a multivariate analysis, both NLR (HR=1.712, 95% CI 1.026-2.858, p=0.040) and PLR (HR=2.051, 95% CI 1.288-3.267, p=0.002) had independent prognostic value. While a low NLR was associated with a better prognosis only in the IDH-wt GBM group, PLR was predictive of patient survival in the GBM, pGBM, and IDH-wt GBM groups. By contrast, LMR exhibited no prognostic value for any of the 3 types of GBM.

Background: Preoperative hematological markers that indicate nutritional, coagulation, and inflammation statuses have prognostic value for gliomas. This study aimed to investigate hematological markers with regard to tumor grades, isocitrate dehydrogenase mutations (IDH), age, and sex in patients with gliomas.Methods: From 2008 to 2017, patients with a pathological diagnosis of glioma who underwent surgery were retrospectively enrolled in this study. Information from clinical records, including age, sex, preoperative experiment tests (routine blood tests, biochemistry, and coagulation examinations), pathological results, and IDH status, was collected. A univariable survival analysis was performed. Hematological factors such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte-ratio (PLR), and albumin-to-globulin (AGR) were calculated. The prognostic nutrition index (PNI) was calculated as 10 × serum albumin value (g/dl) + 0.005 × peripheral lymphocyte count (per mm3).Results: Our study included 706 patients. The univariate analysis showed that age, IDH-1, and hematological factors were all significantly associated with overall survival (OS) in patients with gliomas. Our results showed that inflammation markers (NLR, PLR, and fibrinogen) were positively associated with age, whereas AGR was negatively associated with age. The PLR was significantly increased, whereas the AGR and PNI were decreased in women with gliomas, as compared with men. We found that inflammation markers increased and nutrition markers decreased with gliomas grade. However, these hematological markers did not significantly differ with IDH status. NLR was the best single hematological marker for distinguishing glioblastoma (GBM) [0.684 (0.645–0.723)], IDH-wt GBM [0.672 (0.631–0.71)] from other gliomas subtypes. Combinations of age with PNI and age with AGR were the best predictors of GBM [0.750 (0.713–0.786)] and IDH-wt GBM [0.759 (0.719–0.798)], respectively.Conclusion: Preoperative hematological marker levels vary among glioma grades and have high predictive values for GBM.

WHO2007 grading of diffuse gliomas in adults is well-established. However, IDH mutations make classification of gliomas according to the WHO2007 edition controversial. Here, we characterized IDH-1R132H mut status in a cohort of 670 adult patients with different WHO2007 grades of diffuse glioma. Patient characteristics, clinical data and prognoses were obtained from medical records. Patients with IDH-1R132H mut were younger and had better clinical outcomes than those without mutations. Differences in age among patients with astrocytomas of different WHO2007 grades were eliminated after patients were grouped based on IDH-1R132H status. IDH-1R132H mut was present more often in patients with lower Ki-67 and MGMT protein levels and higher mutant p53 levels. Ki-67 was also strongly associated with WHO2007 grade independently of IDH-1R132H mut status. Moreover, patients with Ki-67<30 survived longer than those with Ki-67≥30, regardless of IDH-1R132H mut status. Patients in the IDH-1R132H mut group with lower MGMT protein levels also had better clinical outcomes than those in other groups. Our results indicate that to better treat gliomas, IDH mutation status should be included when determining WHO2007 grade in glioma patients.