The Prognostic Role and Nomogram Establishment of a Novel Prognostic Score Combining with Fibrinogen and Albumin Levels in Patients with WHO Grade II/III Gliomas

Abstract

Purpose World Health Organization (WHO) Grades II and III gliomas [also known as low grade gliomas (LGGs)] displayed different malignant behaviors and survival outcomes compared to Grade IV gliomas. This study aimed to identify the prognostic predictive value of a novel cumulative prognostic score [combined with fibrinogen and albumin levels (FA score)], establish and validate a point-based nomogram in LGG patients. Patients and Methods A total of 91 patients who underwent total glioma resection at Shengjing Hospital of China Medical University between 2011 and 2013 were enrolled to establish a prognostic nomogram. All patients were histologically diagnosed as grades II/III, and never received radiotherapy or chemotherapy before surgery. Data collection included patient characteristics, clinicopathological factors, and preoperative hematology results. The performance of the nomogram was subsequently validated by the concordance index (c-index), calibration curve, and receiver operating characteristic (ROC) curve. Results The FA score was negatively associated with the overall survival (OS) of LGG patients (p < 0.001). The results of multivariate analysis showed that FA score [p = 0.006, HR = 1.92, 95% confidence interval (CI): 1.21–3.05], age (p = 0.002, HR = 3.014, 95% CI:1.52–5.97), and white blood count (p < 0.001, HR = 4.24, 95% CI: 2.08–8.67) were independent prognostic factors for overall survival (OS). The study established a nomogram to predict OS with a c-index of 0.783 (95% CI, 0.72–0.84). Conclusion FA score might be a potential prognostic biomarker for LGG patients, and a reliable point-based nomogram will help clinicians to decide on the best treatment plans.

A nomogram combining inflammatory markers and clinical factors predicts survival in patients with diffuse glioma

“…[8,23,24] In addition, eosinophils, macrophages, and platelets are all related to tumor progression. [25][26][27][28][29] High NLR level has been identified as an independent risk factor for OS in a variety of malignancies, including colorectal cancer, [30] ovarian cancer, [31,32] breast cancer, [33] and pancreatic cancer. [34,35] The interaction between inflammation and cancer shows that inflammation may drive the secretion of growth factors and pro-angiogenesis factors, induce tumor cell invasion and metastasis, and lead to tumor progression.…”

“…The relatively elevated neutrophils can enhance the production of inflammatory mediators, and even cause the instability and mutation of the body's genetic status bring the function of DNA repair decrease [8,23,24] . In addition, eosinophils, macrophages, and platelets are all related to tumor progression [25–29] …”