The association of pretreatment neutrophil to lymphocyte ratio with overall survival in patients with glioblastoma multiforme (GBM).

Abstract

2062 Background: GBM is the most common and aggressive primary brain tumor. The neutrophil to lymphocyte ratio (NLR) gives a measure of systemic inflammatory response and lymphopenia, both of which are poor prognostic factors in many malignancies. No published study has assessed the prognostic impact of NLR in GBM. Methods: Patients treated for GBM at our regional referral centre with assessable complete blood count at first presentation (prior to corticosteroid therapy or surgery) were identified. Medical notes were reviewed to extract demographic and treatment data. Survival curves were estimated via Kaplan-Meier method and compared via log-rank method. Multivariate analysis was performed via Cox proportional hazards regression modelling. Results: A total of 86 patients were identified, of which 65(76%) were male. Median age at diagnosis was 58 years (range: 18–76). At the time of analysis all patients still alive had ≥ 2 years follow-up. Median overall survival (OS) was 9.3 months (range: 1-82). 57% completed the standard adjuvant Stupp protocol and 43% discontinued early due to disease progression or treatment toxicity. Median OS was 11.2 months in patients with NLR<4 and 7.5 months in patients with NLR>4 (HR 0.59, p=.04). Other significant prognostic factors based on univariate analysis were consistent with published data (Table). After correcting for known prognostic factors NLR remained a significant predictor of survival (Table). Conclusions: Recent advances in immunotherapy have highlighted the importance of the immune system in the treatment and prognosis of cancer patients. Many GBM patients are on corticosteroids for a significant proportion of their disease course which may abrogate the effects of host immunity on outcome. Nevertheless, we have shown that NLR at diagnosis is an independent predictor of survival in GBM patients. Investigation of therapies which harness the immune response are warranted in this disease. [Table: see text]

Clinicopathological characteristics of histiocytic sarcoma affecting the central nervous system in dogs

“…41 Increased N:L ratios have been associated with poorer overall survival in a variety of cancers in humans, 42 including intracranial gliomas. 43 The N:L ratios were significantly increased in all tumor subgroups in our study compared to normal reference ranges, but the marked pro- 13 14 days (n = 4), 14 and 30 days (n = 5) 15 with no distinction between definitive and palliative treatment. Low sample numbers and marked variability in tumor locations and treatment modalities preclude any detailed analysis of therapeutic outcome in our study, but general comments can be made.…”

High neutrophil to lymphocyte ratio measured before starting ipilimumab treatment is associated with reduced overall survival in patients with melanoma

“…14 Corticosteroid intake was an exclusion criterion in a study of patients with glioblastoma, and an NLR >4 indicated poor outcome in these patients. 27 We found only one study devoted to NLR in cancers that took corticosteroid therapy into account. This study, carried out in patients with lung cancer, demonstrated that an NLR >5 at baseline was a factor predictive of poorer survival, independently of a short course of corticosteroids included in the chemotherapy regimen.…”

Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Advanced Pancreatic Ductal Adenocarcinoma: Impact of Baseline Fluctuation and Changes during Chemotherapy

“…More recently, the relative difference in neutrophil and lymphocyte counts, the neutrophil-to-lymphocyte ratio (NLR), has gained attention as a prognostic biomarker. A high baseline NLR has been shown to correlate with poor outcomes in lung cancer 17 , colorectal cancer 18 , glioblastoma multiforme 19 and pancreatic cancer [20][21][22][23] . It is attractive as it is easy to measure, potentially cost-effective and less likely to be influenced by confounding factors such as infection, inflammatory disease or high-dose corticosteroid use than the absolute leucocyte count 17 .…”