Prognostic significance of pre‑treatment neutrophil‑to‑lymphocyte ratio and platelet‑to‑lymphocyte ratio in patients with glioblastoma

Abstract

Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumour in adults. Identification of accessible and cost-effective prognostic factors may better guide adjuvant treatment-related decisions. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers of host inflammatory response, and their increase has recently been shown to be a poor prognostic factor in several malignancies. The aim of the present study was to investigate the prognostic value of preoperative NLR and PLR in GBM patients. Between 2012 and 2017, 104 patients who had undergone surgery for GBM were considered for adjuvant therapy in our institution. Of those, 80 patients with evaluable pre-corticosteroid full blood count results were identified and included in the final analysis. The Eastern Cooperative Oncology Group performance status, localization, radiochemotherapy and second-line systemic therapy were found to be independent prognostic indicators for progression-free and overall survival. The median overall survival was 13.2 months. Patients with NLR <4 had a better median overall survival of 10.7 vs. 7.8 months in patients with NLR >4; however, this difference was not statistically significant (P>0.05). Overall survival also did not differ significantly between patients with low and those with high PLR values (10.2 vs. 15.2 months, respectively; P=0.105). In conclusion, the results of the present study suggest that pre-treatment NLR and PLR do not have prognostic value in GBM patients; however, large-scale trials are required to confirm these findings.

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 ).…”

“…A high pre‐operative PLR and a low LMR is a predictor of poor prognosis for patients with glioma . On the contrary, some studies have demonstrated that pretreatment PLR or LMR is not associated with improved OS of patients with GBM . This difference may be due to the difference in sample size and cutoff value.…”

“…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.…”

“…19 On the contrary, some studies have demonstrated that pretreatment PLR or LMR is not associated with improved OS of patients with GBM. 13,32 This difference may be due to the difference in sample size and cutoff value. In a study of GBM, Han et al 21 has reported that the prognostic significance of PLR is far less than that of NLR.…”