Comparison of neutrophil to lymphocyte ratio and prognostic nutritional index with other clinical and molecular biomarkers for prediction of glioblastoma multiforme outcome

Abstract

Objective Pre- and post-operative neutrophil to lymphocyte ratio (NLR) and prognostic nutritional index (PNI) and other prognostic clinicopathological variables were correlated with progression free survival (PFS) and overall survival (OS) of Glioblastoma Multiforme (GBM) patients. Methods GBM patients (n = 87, single-centre, recruited 2013–2019) were retrospectively divided into low and high groups using literature-derived cut-offs (NLR = 5.07, PNI = 46.97). Kaplan-Meier survival curves and log rank tests assessed PFS and OS. Univariate and multivariate analyses identified PFS and OS prognosticators. Results High vs low post-operative PNI cohort was associated with longer PFS (279 vs 136 days, p = 0.009), but significance was lost on multivariate analysis. Post-operative ECOG (p = 0.043), daily dexamethasone (p = 0.023) and IDH mutation (p = 0.046) were significant on multivariate analysis for PFS. High pre- and post-operative PNI were associated with improved OS (384 vs 114 days, p = 0.034 and 516 vs 245 days, p = 0.001, respectively). Low postoperative NLR correlated with OS (408 vs 249 days, p = 0.029). On multivariate analysis using forward selection process, extent of resection (EOR) (GTR vs biopsy, p = 0.004 and STR vs biopsy, p = 0.011), and any previous surgery (p = 0.014) were independent prognostic biomarkers for OS. On multivariate analysis of these latter variables with literature-derived prognostic biomarkers, EOR remained significantly associated with OS (p = 0.037). Conclusions EOR, followed by having any surgery prior to GBM, are the most significant independent predictors of GBM patient’s OS. Post-operative ECOG, daily dexamethasone and IDH mutation are independent prognostic biomarkers for PFS. PNI may be superior to NLR. Post- vs pre-operative serum inflammatory marker levels may be associated with survival.

A Simple Preoperative Blood Count to Stratify Prognosis in Isocitrate Dehydrogenase-Wildtype Glioblastoma Patients Treated with Radiotherapy plus Concomitant and Adjuvant Temozolomide

“…The prognostic value of preoperative NLR has been less frequently analyzed for PFS than for OS. We identified five studies in which such analyses were performed and, contrary to our findings, four of these studies reported no correlation between a higher preoperative NLR and poor PFS [ 29 , 36 , 37 , 38 ]. In one study, this correlation was found in patients with GB but was not confirmed when the analysis was limited to the subgroup of patients who completed the Stupp protocol in which a high preoperative NLR was correlated with a shorter OS [ 26 ].…”

“…Mason et al [ 34 ] also confirmed that a high NLR just before or during focal radiotherapy and concomitant TMZ was associated with a poorer prognosis. Five studies reported no significant correlation between NLR and OS in uni- and multivariate analyses with total populations of 84 (cutoff ≥ 4, China) [ 35 ], 80 (cutoff > 4, Turkey) [ 36 ], 89 (cutoff > 2.5, 3 or 4, Israel) [ 37 ], and 87 (cutoff > 5.07, Australia) [ 38 ] GB patients. These discrepancies may reflect differences in hematological instruments, methods for determining cutoff values, sample size, surgical options, and adjuvant treatment regimens.…”

Prognostic value of prognostic nutritional index score and controlling nutritional status score in patients with glioblastoma: A comprehensive meta-analysis

“…Fifth, the extent of surgical resection may have affected the prognosis of patients with glioblastoma. Studies analyzing the effects of gross total resection (GTR), subtotal resection (STR) and biopsy on the prognosis of patients with glioblastoma have found that GTR is beneficial ( 13 – 16 , 23 ). The studies included in the present meta-analysis did not group patients by surgical methods, precluding subgroup analysis to analyze the predictive effect of PNI and CONUT scores on the prognosis of patients with glioblastoma following different surgical methods.…”

“…Although several meta-analyses have analyzed the prognostic roles of inflammatory and nutritional indicators in patients with glioblastoma, those analyses did not emphasize the prognostic value of PNI scores ( 6 , 26 ). Several recent studies, not included in previous meta-analyses, have assessed the prognostic value of PNI scores in patients with glioblastoma ( 5 , 13 – 16 ). Moreover, no meta-analyses to date have analyzed the prognostic role of CONUT score in patients with glioblastoma.…”

Additional diagnostic value of the monocyte to red blood cell count ratio and the product of lymphocyte count and albumin concentration in lung cancer management

“…Various types of immune and inflammatory cells are frequently present within tumours; however, they are more easily captured in the peripheral blood (4). Numerous studies have demonstrated that haematological biomarkers, including the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR), exhibit prognostic value in malignancies such as lung and colorectal cancer (5)(6)(7). High NLR, PLR and MLR values prior to oncotherapy are associated with an unfavourable prognosis of the disease (8,9).…”