Gandhi Puneet, Khare Richa, VasudevGulwani Hanni, Kaur Sukhpreet
Department of Research, Bhopal Memorial Hospital and Research Centre, Bhopal, India.
Department of Pathology, Bhopal Memorial Hospital and Research Centre, Bhopal, India.
Int J Mol Cell Med. 2018 Spring;7(2):111-118. doi: 10.22088/IJMCM.BUMS.7.2.111. Epub 2018 Jul 29.
In addition to histopathological parameters, evaluation of associated hematological factors is essential for devising a sensitive prognostic scale in glioma. Increased neutrophil-lymphocyte ratio (NLR), a marker of systemic inflammatory response, has recently been associated with worse outcome in various cancers. Given that glioma progression is characterized by inflammation, aggressive angiogenesis, and invasion, increased levels of systemic human-chitinase-3-like-one protein (YKL-40) have also been linked to poor prognosis. The aim of the present study was to assess the plausible association of YKL-40, NLR, and platelet count with increasing tumor grade, and evaluate their status as independent prognostic factors in terms of overall survival (OS) in treatment naive patients with diffuse glioma. Plasma levels of both biochemical markers in 72 diffuse gliomas, median age 42 years, were compared with 36 controls. Comparison of YKL-40, NLR, and PC with respect to tumor grade was found to be significant for each of the markers (P <0.0001) while an inverse significant correlation was seen for YKL-40 and NLR with OS (r = -0.4619, P <0.0001, and r = -0.5561, P < 0.0001, respectively). NLR was the best performing marker with AUC 0.9417 at 97% specificity. In addition, YKL-40 had a positive correlation with NLR (r = 0.4902, P <0.0001), indicating that expression of both markers was linked to inflammation and tumor progression as they were significantly correlated with tumor grade. Expression of YKL-40 and NLR was independently associated with worse survival (HR 1.0062, P = 0.039, and HR 1.1787, P = 0.0003, respectively), thus establishing their clinical utility as prognosticators for diffuse gliomas.
除了组织病理学参数外，评估相关血液学因素对于制定胶质瘤敏感的预后量表至关重要。中性粒细胞与淋巴细胞比值（NLR）升高是全身炎症反应的标志物，最近已被证明与多种癌症的不良预后相关。鉴于胶质瘤进展的特征是炎症、侵袭性血管生成和浸润，全身人几丁质酶3样蛋白1（YKL-40）水平升高也与预后不良有关。本研究的目的是评估YKL-40、NLR和血小板计数与肿瘤分级增加之间可能存在的关联，并评估它们作为初治弥漫性胶质瘤患者总生存期（OS）独立预后因素的状况。将72例弥漫性胶质瘤患者（中位年龄42岁）的两种生化标志物血浆水平与36例对照进行比较。发现YKL-40、NLR和血小板计数（PC）与肿瘤分级之间的比较对每种标志物均具有显著性（P<0.0001），而YKL-40和NLR与OS呈显著负相关（r=-0.4619，P<0.0001；r=-0.5561，P<0.0001）。NLR是表现最佳的标志物，在特异性为97%时曲线下面积（AUC）为0.9417。此外，YKL-40与NLR呈正相关（r=0.4902，P<0.0001），表明这两种标志物的表达与炎症和肿瘤进展相关，因为它们与肿瘤分级显著相关。YKL-40和NLR的表达分别与较差的生存率独立相关（风险比[HR]分别为1.0062，P=0.039；HR为1.1787，P=0.0003），从而确立了它们作为弥漫性胶质瘤预后指标的临床实用性。
