Preoperative Changes in Hematological Markers and Predictors of Glioma Grade and Survival

Abstract

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.

Prognostic Significance of Preoperative Systemic Cellular Inflammatory Markers in Gliomas: A Systematic Review and Meta‐Analysis

“…In the analysis of the NLR for predicting the prognosis of gliomas, 15 studies ( n = 2,798 patients) were included. The patients with a higher pre‐operative NLR had a worse prognosis (HR: 1.38; 95% CI: 1.09–1.74; P = 0.008; Figure a ).…”

“…The patients with a higher pre‐operative NLR had a worse prognosis (HR: 1.38; 95% CI: 1.09–1.74; P = 0.008; Figure a ). Moreover, seven studies with 1,575 patients evaluated the PLR for predicting the prognosis of gliomas. There was no significant difference in the prognostic significance of PLR between the patients with low PLR and those with high PLR (HR: 0.99; 95% CI: 0.75–1.29; P = 0.91; Figure b ).…”

“…The blood‐brain barrier is easily impaired in many neurologic tumors, resulting in an easy infiltration of monocytes. Growing evidence indicates that the neutrophil count is positively related with glioma grade, and is an early predictor of tumor progression in patients with GBM . NLR is positively correlated with the proliferation potency of gliomas .…”

“…This interaction between neutrophils and lymphocytes in response to inflammation is of significance in immunosuppression . Secretion of Arginase‐1 by neutrophil supports immunosuppression and VEGF‐A production induces angiogenesis . Neutrophils also promote angiogenesis by inducing a shift of gliomas from the proneural to the mesenchymal subtype, contributing to anti‐angiogenic therapy resistance.…”

“…In total, 3,261 patients diagnosed with glioma from 18 studies were included. 9,11,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] All of the included studies were published in recent years and were from seven different countries, which were retrospectively designed with 17 single-center trials 9,11,[18][19][20]22,[24][25][26][27][28][29][30][31][32][33][34] and one multicenter trial. 23 There were 15 studies performed multivariate Cox regression analysis and reported adjusted HR.…”