Abstract
ObjectivePre- and post-operative neutrophil to lymphocyte ratio (NLR) and prognostic nutritional index (PNI) and other prognostic clinicopathological variables were correlated with progression free survival (PFS) and overall survival (OS) of Glioblastoma Multiforme (GBM) patients.MethodsGBM patients (n = 87, single-centre, recruited 2013–2019) were retrospectively divided into low and high groups using literature-derived cut-offs (NLR = 5.07, PNI = 46.97). Kaplan-Meier survival curves and log rank tests assessed PFS and OS. Univariate and multivariate analyses identified PFS and OS prognosticators.ResultsHigh vs low post-operative PNI cohort was associated with longer PFS (279 vs 136 days, p = 0.009), but significance was lost on multivariate analysis. Post-operative ECOG (p = 0.043), daily dexamethasone (p = 0.023) and IDH mutation (p = 0.046) were significant on multivariate analysis for PFS. High pre- and post-operative PNI were associated with improved OS (384 vs 114 days, p = 0.034 and 516 vs 245 days, p = 0.001, respectively). Low postoperative NLR correlated with OS (408 vs 249 days, p = 0.029). On multivariate analysis using forward selection process, extent of resection (EOR) (GTR vs biopsy, p = 0.004 and STR vs biopsy, p = 0.011), and any previous surgery (p = 0.014) were independent prognostic biomarkers for OS. On multivariate analysis of these latter variables with literature-derived prognostic biomarkers, EOR remained significantly associated with OS (p = 0.037).ConclusionsEOR, followed by having any surgery prior to GBM, are the most significant independent predictors of GBM patient’s OS. Post-operative ECOG, daily dexamethasone and IDH mutation are independent prognostic biomarkers for PFS. PNI may be superior to NLR. Post- vs pre-operative serum inflammatory marker levels may be associated with survival.
Highlights
Glioblastoma Multiforme (GBM), the most common primary malignant brain tumour in adults, has a poor prognosis with an overall survival (OS) estimate of 15.5 months [1]
High vs low post-operative prognostic nutritional index (PNI) cohort was associated with longer progression-free survival (PFS) (279 vs 136 days, p = 0.009), but significance was lost on multivariate analysis
Lopes et al [10] found that preoperative neutrophil to lymphocyte ratio (NLR) was not associated with OS (p = 0.868), it was an independent prognostic marker for PFS (p = 0.032). This may be explained by their inclusion of different adjuvant treatment regimens, whereas we found no significant associations between preoperative NLR, PFS and non-conventional adjuvant chemotherapy
Summary
Glioblastoma Multiforme (GBM), the most common primary malignant brain tumour in adults, has a poor prognosis with an overall survival (OS) estimate of 15.5 months [1]. Biomarkers are vital in early diagnosis of high-risk phenotypes and tumour progression, and may influence treatment decisions, improving clinical outcomes [2]. Current molecular and imaging prognostic GBM biomarkers are limited by their need for tissue analysis, tumour heterogeneity, different detection methods and interobserver variability. Clinical biomarkers are superior in their clinical utility, but do not reveal the pathophysiology underlying GBM. The potential of -obtained serum inflammatory markers like prognostic nutritional index (PNI) and neutrophil to lymphocyte ratio (NLR) to reveal the intricate relationship between the tumour microenvironment and the systemic immune response has been demonstrated in a few studies [3, 4]. PNI reflects immunological response and nutritional status and harbors potential as a modifiable prognostic biomarker for GBM [5,6,7]. Other issues include lack of progression-free survival (PFS) data, exclusive use of preoperative PNI levels, small cohort sizes, and lack of consideration of the potential confounding effect of molecular aberrations
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