Hemoglobin Levels and Red Blood Cells Distribution Width Highlights Glioblastoma Patients Subgroup With Improved Median Overall Survival

Abstract

Glioblastoma multiforme (GBM) is known for its dismal prognosis, though its dependence on patients' readily available RBCs parameters is not fully established. In this work, 170 GBM patients, diagnosed and treated in Soroka University Medical Center (SUMC) over the last 12 years were retrospectively inspected for their survival dependency on pre-operative RBCs parameters. Besides KPS and tumor resection supplemented by oncological treatment, age under 70 (HR = 0.4, 95% CI 0.24-0.65, p = 0.00073), low hemoglobin level (HR = 1.79, 95% CI 1.06-2.99, p = 0.031), and Red Cell Distribution Width (RDW) <14% (HR = 0.57, 95% CI 0.37-0.88, p = 0.018) were found to be prognostic of patients' overall survival in multivariate analysis, accounting for a false discovery rate of < 5% due to multiple hypothesis testing. According to these results, a stratification tree was made, from which a favorable route highlighted a subgroup of nearly 30% of the cohorts' patients whose median overall survival was 21.1 months (95% CI 16.2-27.2)-higher than the established chemo-radiation standard first-line treatment regimen overall median survival average of about 15 months. The beneficial or detrimental effect of RBCs parameters on GBM prognosis and its possible causes is discussed. Keywords: glioblastoma multiforme (GBM), hemoglobin, RDW (red cell distribution width), prognostic factors, overall survival KEY POINTS-GBM resection followed by oncological treatment of patients under the age of 70 with normal hemoglobin level and RDW < 14% enhance patients' survival.-Measures aimed to normalize hemoglobin levels and RDW prior to surgical intervention may be useful in order to improve GBM patients' prognosis.

A Hematological-Related Prognostic Scoring System for Patients With Newly Diagnosed Glioblastoma

“…Recently, studies have demonstrated that hematological markers may reflect the tumor microenvironment to some extent in GBM ( 10 , 17 , 19 , 20 ). Inflammation in the tumor microenvironment promotes angiogenesis, tumor invasion, and metastasis, while increasing tumor cell proliferation and enhancing their survival, and also destroying the body’s innate and adaptive immune responses.…”

“…Several studies have indicated that a state of preoperative hypercoagulability is related to poor prognosis in patients with GBM ( 16 , 17 ). Other factors such as glucose (GLC) ( 18 , 19 ), hemoglobin (HBG) ( 20 , 21 ), the prognostic nutrition index (PNI) ( 14 , 22 , 23 ), lactate dehydrogenase (LDH) ( 24 , 25 ) and red blood cell distribution width (RDW) ( 20 , 26 ) have also been shown to have prognostic value in GBM. Fortunately, these hematological indicators can be obtained from convenient and inexpensive preoperative clinical routine tests.…”

Reinforcing Synthetic Data for Meticulous Survival Prediction of Patients Suffering From Left Ventricular Systolic Dysfunction

“…In anemia condition, a fall in the level of haemoglobin (Hb) results into inefficient oxygen carrying capacity of the blood that eventually increases mortality in CVDs [9], [10]. Similar to a low haemoglobin condition, high hematocrit or Hb levels is also linked to CVDs [11], [12]. In case of hematocrit, body makes too many red blood cells that makes the blood thicker and ultimately lead to clots, heart attacks, and stroke [11], [12].…”

“…Similar to a low haemoglobin condition, high hematocrit or Hb levels is also linked to CVDs [11], [12]. In case of hematocrit, body makes too many red blood cells that makes the blood thicker and ultimately lead to clots, heart attacks, and stroke [11], [12]. Some of the recent studies have directly associated the role of anemia in the dilation of left ventricular leading to left ventricular systolic dysfunction (LVSD) [13], [14].…”

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“…Several studies have indicated that a state of preoperative hypercoagulability is related to poor prognosis in patients with GBM (16,17). Other factors such as glucose (GLC) (18,19), hemoglobin (HBG) (20,21), the prognostic nutrition index (PNI) (14,22,23), lactate dehydrogenase (LDH) (24,25) and red blood cell distribution width (RDW) (20,26) have also been shown to have prognostic value in GBM. Fortunately, these hematological indicators can be obtained from convenient and inexpensive preoperative clinical routine tests.…”