Department of Medical Oncology, Cork University Hospital, Cork, Ireland.
J Neurooncol. 2013 Aug;114(1):149-54. doi: 10.1007/s11060-013-1164-9. Epub 2013 Jun 19.
Neutrophil-lymphocyte ratio (NLR) is a marker of systemic inflammatory response and its elevation has recently been shown to be a poor prognostic factor in many malignancies including colon, prostate and bladder cancer. The primary aim of this study was to assess the prognostic impact of NLR in a clinically annotated cohort of patients with glioblastoma multiforme (GBM). We hypothesised that elevated NLR would be associated with worse prognosis. Between 2004 and 2009, 137 patients had surgery for GBM and were assessed for consideration of adjuvant therapy at our institution. Of these, 84 patients with an evaluable pre-corticosteroid full blood count result were identified and included in the final analysis. Median overall survival was 9.3 months (range 0.7-82.1). On univariate analysis, age >65 years, gender, ECOG performance status ≥2, frontal tumour, extent of surgical resection, completion of adjuvant chemoradiation protocol and NLR > 4 were significantly correlated with overall survival. Patients with NLR > 4, had a worse median overall survival at 7.5 months versus 11.2 months in patients with NLR ≤ 4 (hazard ratio 1.6, 95 % CI 1.00-2.52, p = 0.048). On multivariate analysis NLR > 4 remained an independent prognostic indicator for poor outcome. These data are an important reminder of the potential relevance of host immunity in GBM. In our cohort, NLR > 4 conferred a worse prognosis independent of other well established prognostic factors. If validated in other cohorts NLR may prove to be a useful addition in predicting prognosis in GBM patients. The demonstration that host immunity plays a role in GBM biology suggests that investigation of emerging therapies which modulate host immune response are warranted in this disease.
中性粒细胞与淋巴细胞比值（NLR）是全身炎症反应的标志物，最近的研究表明，其升高与多种恶性肿瘤（包括结肠癌、前列腺癌和膀胱癌）的预后不良有关。本研究的主要目的是评估 NLR 在多形性胶质母细胞瘤（GBM）的临床注释队列中的预后影响。我们假设 NLR 升高与预后不良相关。在 2004 年至 2009 年间，有 137 名患者接受了 GBM 的手术治疗，并在我们的机构评估了辅助治疗的考虑因素。在这些患者中，有 84 名患者有可评估的皮质类固醇前全血计数结果，被确定并纳入最终分析。中位总生存期为 9.3 个月（范围 0.7-82.1）。单因素分析显示，年龄>65 岁、性别、ECOG 表现状态≥2、额叶肿瘤、手术切除范围、辅助放化疗方案完成情况和 NLR>4 与总生存期显著相关。NLR>4 的患者中位总生存期为 7.5 个月，而 NLR≤4 的患者中位总生存期为 11.2 个月（风险比 1.6，95%CI 1.00-2.52，p=0.048）。多因素分析显示，NLR>4 仍然是预后不良的独立预测指标。这些数据重要地提醒人们宿主免疫在 GBM 中的潜在相关性。在我们的队列中，NLR>4 是独立于其他公认的预后因素的不良预后指标。如果在其他队列中得到验证，NLR 可能成为预测 GBM 患者预后的有用指标。宿主免疫在 GBM 生物学中发挥作用的证据表明，在这种疾病中，有必要研究新兴的调节宿主免疫反应的治疗方法。
