Preoperative Immune-Inflammatory Status of the Patients With Newly-Diagnosed Glioblastoma – Could It Genuinely Predict Their Survival?

Serban, Georgiana M; Tamas, Corina I; Tamas, Flaviu; Balasa, Adrian F

doi:10.7759/cureus.43802

Cited by 5 publications

(2 citation statements)

References 31 publications

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“…Higher eosinophil counts have been associated with better prognoses in GBM. Conversely, the SII and the SIRI, which indicate a predominant inflammatory response, are often associated with poorer outcomes [21]. Cell-free DNA (cfDNA) consists of DNA fragments released from cells undergoing cell death.…”

Section: Discussionmentioning

confidence: 99%

Sequential Evaluation of Hematology Markers as a Prognostic Factor in Glioblastoma Patients

Gonçalves,

Carvalho,

Tuna

et al. 2024

Biomedicines

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In our study, we investigated the prognostic significance of hematological markers—NLR (Neutrophil-to-Lymphocyte Ratio), PLR (Platelet-to-Lymphocyte Ratio), and RDW-CV (Red Blood Cell Distribution Width—Coefficient of Variation)—in 117 glioblastoma patients. The data collected from January 2016 to December 2018 included demographics, clinical scores, and treatment regimens. Unlike previous research, which often examined these markers solely before surgery, our unique approach analyzed them at multiple stages: preoperative, postoperative, and before adjuvant therapies. We correlated these markers with the overall survival (OS) and progression-free survival (PFS) using statistical tools, including ANOVA, Cox regression, and Kaplan–Meier survival analyses, employing SPSS version 29.0. Our findings revealed notable variations in the NLR, PLR, and RDW-CV across different treatment stages. The NLR and PLR decreased after surgery, with some stabilization post-STUPP phase (NLR: p = 0.007, η2p = 0.06; PLR: p = 0.001, η2p = 0.23), while the RDW-CV increased post-surgery and during subsequent treatments (RDW-CV: p < 0.001, η2p = 0.67). Importantly, we observed significant differences between the preoperative phase and other treatment phases. Additionally, a higher NLR and RDW-CV at the second-line treatment and disease progression were associated with an increased risk of death (NLR at 2nd line: HR = 1.03, p = 0.029; RDW-CV at progression: HR = 1.14, p = 0.004). We proposed specific marker cut-offs that demonstrated significant associations with survival outcomes when applied to Kaplan–Meier survival curves (NLR at 2nd line < 5: p < 0.017; RDW-CV at progression < 15: p = 0.007). An elevated NLR and RDW-CV at later treatment stages correlated with poorer OS and PFS. No significant preoperative differences were detected. These biomarkers may serve as non-invasive tools for glioblastoma management.

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Section: Discussionmentioning

confidence: 99%

Sequential Evaluation of Hematology Markers as a Prognostic Factor in Glioblastoma Patients

Gonçalves,

Carvalho,

Tuna

et al. 2024

Biomedicines

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“…Baseline NLR increases with glioma progression (grade I-IV glioma), with the highest NLR values observed in patients with grade IV gliomas, followed by grade III and grade I-II gliomas ( 85 – 92 ). In addition, in a retrospective study of adult patients with not otherwise specified subtype of glioblastoma (n=89), a weak positive association was found between tumor size and preoperative NLR values (Spearman r=0.3212, p=0.0493) ( 93 ). In another retrospective study of patients with glioma (n=64), higher pretreatment NLR was significantly associated with larger tumor diameter (p=0.02) ( 94 ).…”

Section: A High Neutrophil-to-lymphocyte Ratio Is An Independent Prog...mentioning

confidence: 99%

Systemic and local immunosuppression in glioblastoma and its prognostic significance

Stepanenko,

Sosnovtseva,

Valikhov

et al. 2024

Front. Immunol.

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The effectiveness of tumor therapy, especially immunotherapy and oncolytic virotherapy, critically depends on the activity of the host immune cells. However, various local and systemic mechanisms of immunosuppression operate in cancer patients. Tumor-associated immunosuppression involves deregulation of many components of immunity, including a decrease in the number of T lymphocytes (lymphopenia), an increase in the levels or ratios of circulating and tumor-infiltrating immunosuppressive subsets [e.g., macrophages, microglia, myeloid-derived suppressor cells (MDSCs), and regulatory T cells (Tregs)], as well as defective functions of subsets of antigen-presenting, helper and effector immune cell due to altered expression of various soluble and membrane proteins (receptors, costimulatory molecules, and cytokines). In this review, we specifically focus on data from patients with glioblastoma/glioma before standard chemoradiotherapy. We discuss glioblastoma-related immunosuppression at baseline and the prognostic significance of different subsets of circulating and tumor-infiltrating immune cells (lymphocytes, CD4+ and CD8+ T cells, Tregs, natural killer (NK) cells, neutrophils, macrophages, MDSCs, and dendritic cells), including neutrophil-to-lymphocyte ratio (NLR), focus on the immune landscape and prognostic significance of isocitrate dehydrogenase (IDH)-mutant gliomas, proneural, classical and mesenchymal molecular subtypes, and highlight the features of immune surveillance in the brain. All attempts to identify a reliable prognostic immune marker in glioblastoma tissue have led to contradictory results, which can be explained, among other things, by the unprecedented level of spatial heterogeneity of the immune infiltrate and the significant phenotypic diversity and (dys)functional states of immune subpopulations. High NLR is one of the most repeatedly confirmed independent prognostic factors for shorter overall survival in patients with glioblastoma and carcinoma, and its combination with other markers of the immune response or systemic inflammation significantly improves the accuracy of prediction; however, more prospective studies are needed to confirm the prognostic/predictive power of NLR. We call for the inclusion of dynamic assessment of NLR and other blood inflammatory markers (e.g., absolute/total lymphocyte count, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammation index, and systemic immune response index) in all neuro-oncology studies for rigorous evaluation and comparison of their individual and combinatorial prognostic/predictive significance and relative superiority.

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Altered coagulation profile of patients with high-grade glioma: clinical study with control group.

Quispe-Pastor,

Gorritti-Rubio,

Fernández-Rodríguez

2024

F1000Res

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Background Activation of coagulation is a common phenomenon in patients with high-grade glioma, a primary malignant brain tumor. Objective Identify if there is an alteration in the coagulation profile in patients with high-grade glioma compared to other patients with benign brain tumors. Methods Sociodemographic and clinical characteristics, ECOG at admission, prothrombin time, activated partial thromboplastin time, international normalized ratio, platelet count, and blood panel results of 21 high-grade glioma patients (cases) and 42 meningioma patients (controls) from northern Peru were reviewed. Bivariate and multivariate analysis with logistic regression were performed to determine which factors are associated with glioma. Results Both groups had high proportions of high blood pressure (29%) and diabetes mellitus (14%). According to multivariate analysis, altered values for prothrombin time, platelet count, and ECOG score were associated with glioma (p=0.01). Furthermore, alterations in the blood panel were observed in both cases and controls but failed to reach statistical significance. Conclusion Patients with high-grade glioma seem to suffer more from hypercoagulable states than other patients with benign brain tumors, suggesting careful vigilance and anticoagulant treatment for these patients.

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Preoperative Immune-Inflammatory Status of the Patients With Newly-Diagnosed Glioblastoma – Could It Genuinely Predict Their Survival?

Cited by 5 publications

References 31 publications

Sequential Evaluation of Hematology Markers as a Prognostic Factor in Glioblastoma Patients

Sequential Evaluation of Hematology Markers as a Prognostic Factor in Glioblastoma Patients

Systemic and local immunosuppression in glioblastoma and its prognostic significance

Altered coagulation profile of patients with high-grade glioma: clinical study with control group.

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