A Novel Scoring System Based on Preoperative Routine Blood Test in Predicting Prognosis of Atypical Meningioma

Abstract

The aim of this study was to explore the correlation and clinical significance of preoperative fibrinogen and neutrophil-lymphocyte ratio (F-NLR) scoring system with 3-year progression-free survival (PFS) of patients with atypical meningioma. Materials and Methods: Clinical, pathological, radiological, and laboratory variables were collected to analyze their correlation with 3-year PFS in the training set with 163 patients. Patients were classified by different F-NLR scores (0, 1, or 2). External validation for the predictive value of F-NLR scoring system was performed in the validation set with 105 patients. Results: Overall, 37.3% (100 of 268) of the enrolled patients were male. The scoring system showed good performance in predicting 3-year PFS (AUC = 0.872, 95%CI = 0.811-0.919, sensitivity = 66.1%, specificity = 93.3%, and Youden index = 0.594). DeLong's test indicated that the AUC of F-NLR scoring system was significantly greater than that of fibrinogen level and NLR (Z = 2.929, P = 0.003; Z = 3.376, P < 0.001). Multivariate Cox analysis revealed that tumor size (HR = 1.39, 95%CI = 1.10-1.76, P = 0.007), tumor location (HR = 3.11, 95%CI = 1.60-6.95, P = 0.001), and F-NLR score (score of 1: HR = 12.78, 95%CI = 3.78-43.08, P < 0.001; score of 2: HR = 44.58, 95%CI = 13.02-152.65, P < 0.001) remained significantly associated with 3-year PFS. The good predictive performance of F-NLR scoring system was also demonstrated in the validation set (AUC = 0.824, 95%CI = 0.738-0.891, sensitivity = 62.5%, specificity = 87.9%, and Youden index = 0.504). Conclusion: Our study confirmed the correlation and clinical significance of preoperative F-NLR scoring system with 3-year PFS of patients with atypical meningioma. A prospective and large-scale study is required to validate our findings.

FORGE: A Novel Scoring System to Predict the MIB-1 Labeling Index in Intracranial Meningiomas

“…Consequently, those patients in the present study with an elevated CRP and an increased plasma fibrinogen level might have a lower MIB-1 labeling index due to a higher number of M1 phenotype macrophages, which can act as tumoricidal cells via phagocytosis, promoting inflammation, releasing cytotoxic cytokines, and impeding the tumor growth [ 50 , 51 ]. In contrast to the findings with regard to fibrinogen in the present study, Chen et al [ 52 ] investigated the role of preoperative blood tests in predicting the prognosis of atypical meningiomas and found that patients with a higher preoperative fibrinogen level had lower progression-free-survival rate at 3 year follow-up. Therefore, the demonstrated association between fibrinogen and proliferative capability seems to be paradoxical.…”

A Clinical Prognostic Model Based on Preoperative Hematological and Clinical Parameters Predicts the Progression of Primary WHO Grade II Meningioma

“…Numerous studies have demonstrated that hematological parameters have great potential in tumor prognostic stratification (7,9,(19)(20)(21); unlike genetic markers, hematological parameters obtained from preoperative peripheral blood tests have the advantages of non-invasiveness, low cost, and easy access. Previous studies have demonstrated that high preoperative levels of NLR and FIB and low levels of LMR are associated with adverse clinical outcomes of AM (7,11,22). However, these studies have included too few hematological parameters, and, by default, each hematological parameter has the same weighting coefficient to predict the progression of AM; whether some hematological parameters with prognostic value in other tumors have the same effect on AM has not been explored.…”

“…A growing number of studies have suggested that chronic inflammation participates in the occurrence, invasion, and metastasis of tumors ( 8 , 9 , 11 ). In the past few decades, the central nervous system has been considered immune-privileged due to the existence of blood-brain barrier.…”

“…All patients included in this study underwent CT and contrast-enhanced MRI within 5 days before surgery, and some patients underwent Magnetic Resonance Spectroscopy when the diagnosis was difficult. The tumor location was evaluated using gadolinium-enhanced T1-weighted MRI, and skull base location and non-skull base location were defined as described previously ( 11 ). Tumor maximum size was also recorded at this time.…”

“…Numerous studies have shown that the systemic inflammatory response and coagulation cascade play an important role in the origin, proliferation, and invasion of tumors (7)(8)(9)(10). Chen et al reported that preoperative neutrophil-to-lymphocyte ratio (NLR) and fibrinogen (FIB) were related to the PFS of patients with AM (11). Our previous study confirmed the prognostic value of lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and albumin-to-globulin ratio (AGR) in glioma (12); other factors, such as D-dimer (DD), hemoglobin (HBG), lactate dehydrogenase (LDH), and red blood cell distribution width (RDW), have also been shown to be correlated with clinical outcomes in patients with glioma (13).…”