A Novel Scoring System Based on Preoperative Routine Blood Test in Predicting Prognosis of Atypical Meningioma.

Xiaoyong Chen,Dezhi Kang,Chenyu Ding,Zhangya Lin,Gaoqi Zhang,Jianhe Zhang,Guojun Wang,Yuanxiang Lin,Jianjun Gu

doi:10.3389/fonc.2020.01705

Abstract

PurposeThe aim of this study was to explore the correlation and clinical significance of preoperative fibrinogen and neutrophil-lymphocyte ratio (F-NLR) scoring system with 3-year progression-free survival (PFS) of patients with atypical meningioma.Materials and MethodsClinical, pathological, radiological, and laboratory variables were collected to analyze their correlation with 3-year PFS in the training set with 163 patients. Patients were classified by different F-NLR scores (0, 1, or 2). External validation for the predictive value of F-NLR scoring system was performed in the validation set with 105 patients.ResultsOverall, 37.3% (100 of 268) of the enrolled patients were male. The scoring system showed good performance in predicting 3-year PFS (AUC = 0.872, 95%CI = 0.811–0.919, sensitivity = 66.1%, specificity = 93.3%, and Youden index = 0.594). DeLong’s test indicated that the AUC of F-NLR scoring system was significantly greater than that of fibrinogen level and NLR (Z = 2.929, P = 0.003; Z = 3.376, P < 0.001). Multivariate Cox analysis revealed that tumor size (HR = 1.39, 95%CI = 1.10–1.76, P = 0.007), tumor location (HR = 3.11, 95%CI = 1.60–6.95, P = 0.001), and F-NLR score (score of 1: HR = 12.78, 95%CI = 3.78–43.08, P < 0.001; score of 2: HR = 44.58, 95%CI = 13.02–152.65, P < 0.001) remained significantly associated with 3-year PFS. The good predictive performance of F-NLR scoring system was also demonstrated in the validation set (AUC = 0.824, 95%CI = 0.738–0.891, sensitivity = 62.5%, specificity = 87.9%, and Youden index = 0.504).ConclusionOur study confirmed the correlation and clinical significance of preoperative F-NLR scoring system with 3-year PFS of patients with atypical meningioma. A prospective and large-scale study is required to validate our findings.

Highlights

Meningioma is a common type of intracranial tumor with three grades of malignancy [1]
Neutrophil count, lymphocyte count, neutrophillymphocyte ratio (NLR), plasma fibrinogen level, tumor size, and extent of resection were significantly different between the two groups
We found a moderate predictive value of fibrinogen level (AUC = 0.786, 95%CI = 0.715–0.846, sensitivity = 77.1%, specificity = 71.1%, and Youden index = 0.482) in atypical meningioma relapsing at 3 year after surgery

Summary

Introduction

Meningioma is a common type of intracranial tumor with three grades of malignancy [1]. Atypical meningioma is considered as a transitional type between benign and malignant meningioma. The WHO grade II meningioma presents a malignant tendency with an approximately recurrence rate of 40% [2, 3]. Patients with atypical meningioma had an average rate of 50% for 5-year progression-free survival (PFS) [4]. The optimal management of patients with atypical meningioma remained controversial mainly because of the difficulty for predicting tumor recurrence. The existing studies suggested that surgical resection, imaging, postoperative radiation therapy (PORT), and pathologic features could be reliable predictors for atypical meningioma [5,6,7,8]. There is no general consensus on which predicative factor is most clinically effective and meaningful

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