Abstract
BackgroundMarkers of systemic inflammation are correlated with patient survival in various cancers. The prognostic value of neutrophil-to-lymphocyte ratio (NLR) was compared with that of platelet-to-lymphocyte ratio (PLR) in patients with glioblastoma. The association of NLR with neutrophil and T- cell infiltration was also explored.MethodsA total of 152 patients with glioblastoma were retrospectively analyzed. Clinical information was obtained from electronic medical records. Kaplan-Meier analysis and the Cox proportional hazards models were used to examine the survival function of pre-treatment NLR and PLR in these glioblastoma patients. Neutrophil and CD3+ T-cell infiltration was assessed by immunohistochemical staining of tissue microarray cores from glioblastomas.ResultsPre-treatment NLR levels were significantly correlated with overall survival (OS) in glioblastoma patients (multivariate hazard ratio =1.050; 95 % confidence interval, 1.003–1.100; P = 0.037). Despite the correlation between NLR and PLR (R = 0.509, P < 0.001), NLR was superior to PLR as a prognostic factor. High pre-treatment NLR (≥4 versus < 4) was significantly associated with high neutrophil infiltration and low CD3+ T-cell infiltration into tumors, and predicted poor OS (mean, 10.6 vs. 17.9 months, P < 0.001).ConclusionsPre-treatment NLR is of prognostic significance independent of MGMT status and is superior to PLR as a prognostic factor. Our results demonstrate a correlation between elevated peripheral blood NLR levels and increased tumor neutrophil infiltration/decreased CD3+ T-cell infiltration.
Highlights
Markers of systemic inflammation are correlated with patient survival in various cancers
Clinicopathologic data of the 152 glioblastoma patients are summarized in Table 1; 106 (69.7 %) patients were under and 46 (30.3 %) were over 60 years of age
We further examined the influence of pre-treatment neutrophil-to-lymphocyte ratio (NLR) on overall survival (OS) across strata of other potential predictors, including age, Karnofsky performance status (KPS), degree of resection, and methylguanine-DNA methyltransferase (MGMT) promoter methylation status
Summary
Markers of systemic inflammation are correlated with patient survival in various cancers. Despite receiving the same treatment, glioblastoma patients show significant variation in their clinical outcomes because of the heterogeneity of the tumors and multiple systemic factors [3]. Tumor-infiltrating immune cells, including neutrophils and lymphocytes, play an important role in glioblastoma progression and prognosis [5,6,7,8,9,10], reflecting the significance of local inflammatory factors. The prognostic value of neutrophil-to-lymphocyte ratio (NLR) in peripheral blood, a marker of systemic inflammatory responses, was identified in glioblastoma [12, 13] and in many other types of cancer [14,15,16]. NLR >4 is an independent prognostic indicator of poor outcome [12, 13]
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