Clinical Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti of Ancona, Italy.
Clinical Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti of Ancona, Italy.
Clin Neurol Neurosurg. 2020 Oct;197:106162. doi: 10.1016/j.clineuro.2020.106162. Epub 2020 Aug 17.
Several hematological factors, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutrition index (PNI) and albumin-to-globulin ratio (AGR), have been highlighted as systemic worse prognostic parameters for the outcome in gliomas. The aim of this study is to identify some pre-operative routinely blood tests as predictive parameters for the Overall Survival (OS) and Progression Free Survival (PFS) in glioblastoma (GBM).
From January 2013 to April 2019, 124 patients operated for glioblastoma were analyzed. Data were collected regarding age, sex, Karnofsky performance status (KPS), IDH status, the extent of resection (EOR) and adjuvant therapy. The hematological parameters were collected at admission: neutrophils, lymphocytes and platelets, hemoglobin, lactate dehydrogenase, albumin, NLR, PLR, AGR and PNI. The OS and the PFS were considered as the end-point for the evaluation of the predictive factors.
A pre-operative neutrophil count > 7 × 10/L was a worse prognostic factor for OS and PFS at univariate analysis (p = 0.004 and p = 0.025), as well as hypo-albuminemia. Thrombocytosis, lymphopenia and NLR > 4 were associated to a worse OS, at uni- and multivariate analysis, resulting as poor predictive parameters, independently to EOR, the IDH mutation and the adjuvant therapy.
Still nowadays there are no sensitive or specific hematological markers which are routinely applied for detecting and monitoring the treatment-response and the prognosis of glioblastoma. In our study, a pre-operative low cost and widely used blood markers, such as NLR, lymphocytes and platelets could be predictable prognostic factors for the Overall Survival of patients affected by glioblastomas.
几项血液学因素，如中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、预后营养指数（PNI）和白蛋白与球蛋白比值（AGR），已被强调为胶质瘤患者预后的全身性不良预后参数。本研究旨在确定一些术前常规血液检查作为预测胶质母细胞瘤（GBM）总生存期（OS）和无进展生存期（PFS）的参数。
本研究共纳入了 124 名于 2013 年 1 月至 2019 年 4 月期间因 GBM 接受手术的患者。收集了患者的年龄、性别、卡氏功能状态评分（KPS）、异柠檬酸脱氢酶（IDH）状态、肿瘤切除程度（EOR）和辅助治疗等数据。入院时收集了血液学参数：中性粒细胞、淋巴细胞和血小板、血红蛋白、乳酸脱氢酶、白蛋白、NLR、PLR、AGR 和 PNI。OS 和 PFS 被视为评估预测因素的终点。
单因素分析显示，术前中性粒细胞计数＞7×10/L 是 OS 和 PFS 的不良预后因素（p=0.004 和 p=0.025），同时伴有低白蛋白血症。血小板增多、淋巴细胞减少和 NLR＞4 在单因素和多因素分析中与 OS 较差相关，是独立于 EOR、IDH 突变和辅助治疗的不良预测参数。
目前尚无敏感或特异性的血液学标志物可用于常规检测和监测胶质母细胞瘤的治疗反应和预后。在本研究中，术前一种低成本且广泛应用的血液标志物，如 NLR、淋巴细胞和血小板，可能是预测胶质母细胞瘤患者总体生存的预后因素。
