Peripheral Inflammatory Blood Markers in Diagnosis of Glioma and IDH Status

Abstract

Objective Gliomas are the most common intracranial tumors. Histopathology and neuroimaging are the main modalities used for diagnosis and treatment response monitoring. However, both are expensive and insensitive methods and can cause neurological deterioration. This study aimed to develop a minimally invasive peripheral inflammatory biomarker for diagnosis of glioma, its grade, and isocitrate dehydrogenase (IDH) status. Materials and Methods Patients undergoing surgery for glioma, acoustic neuroma, and meningioma between January 2019 and December 2019 were included. Preoperative neutrophil/lymphocyte ratio (NLR), derived NLR (dNLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), eosinophil/lymphocyte ratio (ELR), and prognostic nutritional index (PNI) were calculated. Histopathology and immunohistochemistry (IHC) staining were done postoperatively. Results A total of 154 patients of glioma, 36 patients of acoustic neuroma, 58 patients of meningioma, and 107 healthy controls were included. dNLR showed the maximum area under the curve (AUC) (0.656639) for diagnosis of glioma from other tumors and among combinations. dNLR +NLR showed the maximum AUC (0.647865). Maximum AUC for glioblastoma multiforme (GBM) versus other grades and among combinations was shown by NLR (0.83926). NLR + dNLR had the maximum AUC (0.764794). NLR showed significant p value in differentiating IDH wild from IDH mutant GBM. Conclusion dNLR has the maximum diagnostic value in diagnosing glioma from other tumors. NLR (AUC = 0.83926) showed the highest accuracy for GBM diagnosis and may be a parameter in predicting the grade of glioma; also, it has maximum diagnostic value in differentiating IDH wild GBM from IDH mutant GBM. These peripheral inflammatory parameters may prove to be sensitive and cost-effective markers for glioma diagnosis, predicting grade of glioma, monitoring of treatment response, and in predicting recurrence.

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

“…dNLR, which is based on WBC and neutrophil counts, was initially defined by Proctor et al [ 39 ]. The diagnostic value of preoperative dNLR for predicting glioma grade has been highlighted [ 15 , 40 ]. Our findings are consistent with those of Madhugiri et al [ 31 ] showing an association of higher dNLR with shorter OS in GB patients.…”

“…Most IDH-mutant GB are secondary GB developing from low-grade gliomas and are less aggressive than de novo or primary IDH-wildtype GB [ 12 ]. It has been shown that IDH1 mutation is associated with lower levels of chronic inflammation, potentially accounting for the better prognosis of patients with such mutations [ 13 , 14 , 15 ]. In its new classification of central nervous system tumors, the World Health Organization (WHO) refers to IDH-mutant GB as grade 4 mutated IDH astrocytoma to distinguish more clearly between this entity and non-mutated IDH GB [ 16 , 17 ].…”

Novel molecular panel for evaluating systemic inflammation and survival in therapy naïve glioma patients

“…In the present cohort analysis, the NLR score emerged as a good indicator of prognosis and survival in the molecularly typed sub-groups. Concurrence of this result can be found in studies conducted on smaller groups of GB patients[ 31 , 32 ] which show that there is a significant association of NLR with OS[ 33 - 36 ]. Our previous work on diffuse gliomas, along with the current study on IDH characterized gliomas, provides substantial laboratory-based evidence that NLR is a marker of inflammation and can be used as a prognosticator in the clinical setting[ 18 ].…”

Distinguishing brain abscess from necrotic glioblastoma using MRI-based intranodular radiomic features and peritumoral edema/tumor volume ratio

“…As mentioned above, inflammatory factors play a significant role in the pathophysiologic development of both diseases. Previous studies have also suggested that inflammation may act as a hallmark of cancer and highlight the diagnostic value of preoperative inflammatory markers and their ratios in glioma patients [32][33][34][35][36]. Meanwhile, several studies have demonstrated a moderate elevation of the leukocyte and Creactive protein (CRP) levels in brain abscess, which may aid in the differential diagnosis [37][38][39].…”