Influence of neutrophil–lymphocyte ratio in prognosis of glioblastoma multiforme

Lopes, Marta; Carvalho, Bruno; Vaz, Ruí; Linhares, Paulo

doi:10.1007/s11060-017-2641-3

Cited by 77 publications

(85 citation statements)

References 36 publications

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“…We did not find any statistically significant association between neutrophil, lymphocyte, or platelets or their ratios like NLR and PLR, as has been previously suggested in other studies in in solid tumors as well as in brain tumors, DLBCL, and PCNSL . A recent retrospective study analyzing the potential prognostic impact of NLR in a cohort of 62 patients with PCNSL showed that high NLR (≥2) was associated with poor prognosis in univariate analysis but not in multivariate analysis .…”

Section: Discussionsupporting

confidence: 62%

Pretreatment Hemoglobin as an Independent Prognostic Factor in Primary Central Nervous System Lymphomas

Garcilazo

Ibáñez-Juliá

et al. 2019

The Oncologist

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Background Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal lymphoma. Despite established clinical prognostic scoring such as that of the Memorial Sloan Kettering Cancer Center (MSKCC) and the International Extranodal Lymphoma Study Group, outcome prediction needs to be improved. Several studies have indicated an association between changes in hematologic laboratory parameters with patient outcomes in PCNSL. We sought to assess the association between hematological parameters and overall survival (OS) in patients with PCNSL. Methods Pretreatment blood tests were analyzed in patients with newly diagnosed PCNSL (n = 182), and we divided the analysis into two cohorts (A and B, both n = 91). OS was evaluated using the Cox proportional hazards models and log‐rank test. Furthermore, the accuracy of the different multivariate models was assessed by Harrell's concordance index (C‐index). Results Using prechemotherapy blood tests, anemia was found in 38 patients (41.8%) in cohort A and 34 patients (37.4%) in cohort B. In univariate analysis, anemia (<12 g/dL in women and <13 g/dL in men) was significantly associated with OS. None of the other blood tests parameters (neutrophils, lymphocyte, or platelets counts) or their ratios (neutrophil‐to‐lymphocyte ratio and neutrophil‐to‐platelets ratio) were associated with OS. In multivariate analysis, after adjusting by MSKCC score, anemia remained an independent prognostic factor. Interestingly, the prediction accuracy of OS using Harrell's C‐index was similar using anemia or MSKCC (mean C‐index, 0.6) and was increased to 0.67 when combining anemia and MSKCC. Conclusion The presence of anemia was associated with poor prognosis in both cohorts of PCNSL. Validation of these results and biologic role of hemoglobin levels in PCNSL requires further investigation. Implications for Practice The prediction of the outcome of primary central nervous system lymphoma (PCNSL) using the most frequently used scores (i.e., Memorial Sloan Kettering Cancer Center [MSKCC] or International Extranodal Lymphoma Study Group) needs to be improved. We analyzed a large cohort of PCNSL to dissect the potential prognostic value of blood tests in this rare entity. We found anemia as an independent predictor for overall survival in PCNSL. Interestingly, the accuracy to predict PCNSL outcome was improved using hemoglobin level. This improvement was additional to the currently used clinical score (i.e., MSKCC). Finally, none of the other blood tests parameters or their ratios had a prognostic impact in this study.

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Section: Discussionsupporting

confidence: 62%

Pretreatment Hemoglobin as an Independent Prognostic Factor in Primary Central Nervous System Lymphomas

Garcilazo

Ibáñez-Juliá

et al. 2019

The Oncologist

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“…All of the included studies were published in recent years and were from seven different countries, which were retrospectively designed with 17 single‐center trialsand one multicenter trial . There were 15 studies performed multivariate Cox regression analysis and reported adjusted HR . The main features of the selected studies are shown in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…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 ).…”

Section: Resultsmentioning

confidence: 99%

“…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 ).…”

Section: Resultsmentioning

confidence: 99%

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Prognostic Significance of Preoperative Systemic Cellular Inflammatory Markers in Gliomas: A Systematic Review and Meta‐Analysis

Wang¹,

Kang

Lin

et al. 2019

Clinical Translational Sci

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Glioma is the most common malignant brain tumor and has high lethality. This tumor generated a robust inflammatory response that results in the deterioration of the disease. However, the prognostic role of systemic cellular inflammatory indicators in gliomas remains controversial. This meta‐analysis aimed to assess the prognostic significance of preoperative neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), red cell distribution width (RDW), and prognostic nutritional index (PNI) in patients with gliomas. Databases of PubMed, EMBASE, Web of Science, and The Cochrane Library were systematically searched for all studies published up to January 2019. Study screening and data extraction followed established Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. The Newcastle–Ottawa Scale was used to assess the quality of studies. Eighteen studies containing 3,261 patients were included. The analyses showed an increased NLR or RDW was found to be an independent predictor of worse survival in patients with gliomas (hazard ratio (HR): 1.38; 95% confidence interval (CI): 1.09–1.74; P = 0.008; and HR: 1.40; 95% CI: 1.13–1.74; P = 0.002, respectively). Furthermore, a higher PNI indicates a better overall survival (OS; HR: 0.57; 95% CI: 0.42–0.77; P = 0.0002). For the evaluation of PLR and LMR, none of these variables correlated with OS (P = 0.91 and P = 0.21, respectively). Our meta‐analysis indicates the NLR, RDW, and PNI rather than PLR and LMR are the independent index for predicting the OS of gliomas. Pre‐operative NLR, RDW, and PNI can help to evaluate disease progression, optimize treatment, and follow‐up in patients with gliomas.

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“…Glioblastoma is an aggressive cancer type originating from astrocytes and is marked by high levels of neutrophilic inflammation 17 with high neutrophil-to-lymphocyte ratios and neutrophil activity correlating with enhanced tumor progression and poor patient outcomes 18–20 , however little is known about neutrophil interaction with early transformed astrocytes in vivo . The zebrafish larval model allows for unparalleled non-invasive imaging of the early stages of tumor initiation as well as interactions between tumor-initiating cells and immune cells.…”

Section: Introductionmentioning

confidence: 99%

Cxcr1 mediates recruitment of neutrophils and supports proliferation of tumor-initiating astrocytes in vivo

Powell

Meng

Barros-Becker

et al. 2018

Sci Rep

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Neutrophils are first-responders to sites of infection and tissue damage including the inflamed tumor microenvironment. Increasing evidence suggests that crosstalk between tumors and neutrophils can affect the progression of established tumors. However, there is a gap in our understanding of the early events that lead to neutrophil recruitment to oncogene-transformed cells and how these pathways alter tumor progression. Here, we use optically transparent zebrafish larvae to probe the early signals that mediate neutrophil recruitment to Kras-transformed astrocytes. We show that zebrafish larvae with impaired neutrophil function exhibit reduced proliferation of transformed astrocytes supporting a critical role for tumor-associated neutrophils in the early progression of tumorigenesis. Moreover, using mutants and pharmacological inhibition, we show that the chemokine receptor Cxcr1 promotes neutrophil recruitment, proliferation of tumor-initiating cells, and neoplastic mass formation. These findings highlight the power of the larval zebrafish system to image and probe early events in the tumor-initiating microenvironment and demonstrate the potential for neutrophil recruitment signaling pathways such as Cxcl8-Cxcr1 as targets for anti-cancer therapies.

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Influence of neutrophil–lymphocyte ratio in prognosis of glioblastoma multiforme

Cited by 77 publications

References 36 publications

Pretreatment Hemoglobin as an Independent Prognostic Factor in Primary Central Nervous System Lymphomas

Pretreatment Hemoglobin as an Independent Prognostic Factor in Primary Central Nervous System Lymphomas

Prognostic Significance of Preoperative Systemic Cellular Inflammatory Markers in Gliomas: A Systematic Review and Meta‐Analysis

Cxcr1 mediates recruitment of neutrophils and supports proliferation of tumor-initiating astrocytes in vivo

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