Preoperative Survival Prediction in Patients With Glioblastoma by Routine Inflammatory Laboratory Parameters

Abstract

Background: Glioblastoma (GBM) is the most common malignant brain tumor in adults and still carries a dismal prognosis. As several studies detected a connection between inflammation and GBM prognosis, we sought to explore possible associations between routinely investigated inflammatory parameters and GBM outcome. Patients and Methods: Patients treated for GBM at our Institution between 2004 and 2014 were included. White blood cell count (WBC), C-reactive protein (CRP) and the ratio of platelets and WBC (Plt/WBC) were evaluated preoperatively. Medical records were reviewed for clinical parameters (age, sex, preoperative clinical condition, genetic alterations). Study endpoints were overall (OS) and 1-and 2-year survival. Results: In the final cohort consisting of 565 individuals with GBM, univariate analysis showed significant associations for WBC, CRP and Plt/WBC ratio with OS. Kaplan-Meier survival plot confirmed significantly poorer OS in patients with WBC>12/nl and with CRP≥2.9 mg/dl. In multivariate analysis, a WBC of >12/nl was an independent prognostic factor for all three outcome parameters and CRP≥2.9 mg/dl for OS and 1-year survival. Conclusion: Preoperative WBC and CRP values were confirmed as independent predictors of GBM outcome. This emphasizes the need for further evaluation of the role of inflammation in the prognosis of GBM.

Targeted Genomic Sequencing Reveals Different Evolutionary Patterns Between Locally and Distally Recurrent Glioblastomas

“…Our observations support the previous notions that locally and distally recurrent glioblastomas exhibit different evolutionary patterns, in particular, linear and branching evolutions, respectively, and that the location of tumor recurrence helps predict the evolutionary pattern in glioblastoma. Concurrent chemoradiation therapy exerts a powerful selective pressure, and chemo-and radio-resistant cell clones contribute to the development of glioblastoma recurrence (7,(40)(41)(42)(43)(44). Common ancestral cells are likely to pre-exist in the untreated primary glioblastoma and are positively selected by chemoradiation therapy (18,41,(45)(46)(47).…”

Baseline Serum C-Reactive Protein and Plasma Fibrinogen-Based Score in the Prediction of Survival in Glioblastoma

“…p-values of the Student's t-test are shown. and 1-year survival (18). Some possible mechanisms elucidating the increased risk and poor prognosis of high CRP levels in gliomas have been reported (55).…”

“…Moreover, high levels of fibrinogen in the plasma are associated with shorter survival in a variety of cancers (14)(15)(16)(17). Furthermore, C-reactive protein (CRP) was found to be an inflammation-related biomarker that can predict survival in GBM (18). However, C-reactive protein levels are not always elevated in patients with GBM, leaving the analysis of only one value in GBM insufficient for a reliable prediction of survival.…”

Early Pulmonary Metastasis After a Surgical Resection of Glioblastoma Multiforme. A Case Report

“…The preoperative assessment of the extent of the lesion, as well as certain preoperative inflammatory markers, have recently been highlighted for their important value in the prognosis and survival of patients [ 12 ].…”