A Simple Preoperative Blood Count to Stratify Prognosis in Isocitrate Dehydrogenase-Wildtype Glioblastoma Patients Treated with Radiotherapy plus Concomitant and Adjuvant Temozolomide

Abstract

Purpose: The survival times of glioblastoma (GB) patients after the standard therapy including safe maximal resection followed by radiotherapy plus concomitant and adjuvant temozolomide are heterogeneous. In order to define a simple, reliable method for predicting whether patients with isocitrate dehydrogenase (IDH)-wildtype GB treated with the standard therapy will be short- or long-term survivors, we analyzed the correlation of preoperative blood counts and their combined forms with progression-free survival (PFS) and overall survival (OS) in these patients. Methods: Eighty-five patients with primary IDH-wildtype GB treated with the standard therapy between 2012 and 2019 were analyzed retrospectively. Cox proportional hazards models and Kaplan–Meier analysis were used to investigate the survival function of preoperative hematological parameters. Results: Preoperative high neutrophil-to-lymphocyte ratio (NLR, >2.42), high platelet count (>236 × 109/L), and low red blood cell (RBC) count (≤4.59 × 1012/L) were independent prognostic factors for poorer OS (p = 0.030, p = 0.030, and p = 0.004, respectively). Moreover, a high NLR was an independent prognostic factor for shorter PFS (p = 0.010). We also found that, like NLR, preoperative high derived NLR (dNLR, >1.89) was of poor prognostic value for both PFS (p = 0.002) and OS (p = 0.033). A significant correlation was observed between NLR and dNLR (r = 0.88, p < 0.001), which had a similar prognostic power for OS (NLR: AUC = 0.58; 95% CI: [0.48; 0.68]; dNLR: AUC = 0.62; 95% CI: [0.51; 0.72]). Two scores, one based on preoperative platelet and RBC counts plus NLR and the other on preoperative platelet and RBC counts plus dNLR, were found to be independent prognostic factors for PFS (p = 0.006 and p = 0.002, respectively) and OS (p < 0.001 for both scores). Conclusion: Cheap, routinely ordered, preoperative assessments of blood markers, such as NLR, dNLR, RBC, and platelet counts, can predict the survival outcomes of patients with IDH-wildtype GB treated with the standard therapy.

Old and New Systemic Immune-Inflammation Indexes Are Associated with Overall Survival of Glioblastoma Patients Treated with Radio-Chemotherapy

“…In our case study, the neutrophil value was present in the indexes of inflammation and was correlated statistically significantly with the OS rate. Our results are in line with a series of clinical studies reporting high blood neutrophil counts in GBM patients, which are associated with a state of immunosuppression, resistance to treatment, and a worse OS rate [ 14 , 30 , 31 , 32 ]. Even though the mechanism underlying neutrophilia, the recruitment of neutrophils to the tumor infiltrate, and the interplay between tumor cells and non-tumor cells is not yet well understood, once neutrophils reach the inflamed or damaged site, they are crucial for activating innate and adaptive immunity [ 32 ].…”

“…Hence, various immune/inflammation blood products have been investigated to create novel prognostic or predictive models in several solid cancers. Within this context, an elevated neutrophil-to-lymphocyte ratio (NLR) or platelet-to-lymphocyte ratio (PLR) has been associated with increased aggressiveness and shorter survival times in numerous solid cancers [ 13 , 14 ]. Recently, a novel index called the systemic immune-inflammation index (SII), which is based on neutrophil (N), platelet (P), and lymphocyte (L) counts, has emerged and reflects comprehensively the balance of host inflammatory and immune statuses [ 15 ].…”

Management of Recurrent Glioblastomas: What Can We Learn from the French Glioblastoma Biobank?

“…Additional studies based on other -omics approaches are now required, in well-designed cohorts of primary GB samples, taking into account the TFR of GB patients and their survival outcomes. Furthermore, these analyses should not be limited to tumor samples, but should also include the peritumoral brain zone and blood samples, which may contain cellular and molecular components promoting GB growth and invasion [ 50 , 51 , 52 ]. It will also be important to determine why rGB from patients with a long TFR are more aggressive and/or resistant than the initial tumor.…”

COVPRIG robustly predicts the overall survival of IDH wild-type glioblastoma and highlights METTL1+ neural-progenitor-like tumor cell in driving unfavorable outcome

“…69 duplicate and 54 irrelevant records were excluded by evaluating titles and abstracts. Through full-text assessment, editorial and conference abstracts (n = 3), a mixture with LGG or other central nervous system (CNS) tumors (n = 53), a mixture with IDH mutant GBM (n = 22), no prognostic model constructed (n = 17), without evaluation of the predictive ability (n = 26), and not overall survival as the outcome variable (n = 6) were excluded, resulting in 7 eligible studies [14][15][16][17][18][19][20] (Fig. 3A).…”

“…Nevertheless, the clinical application of these novel biomarkers for prognostic prediction remains limited. Recently, several studies have endeavored to develop prognostic models for IDH wild-type GBM based on multi-omics data [14][15][16][17][18][19][20]. Notably, gene-gene (G × G) interactions have profound biological implications.…”