| [Background]Glioma is the most common type of primary brain tumor in adults, accounting for 50%-60% of the intracranial tumor. The majority type of the glioma is highly malignant astrocytoma. Foreign research reported that glioblastoma accounts for 35%～45% of primary brain malignant tumor. Glioma progresses quickly, with charcteristics of high recurrence, and high mortality, the 5-year survival rate is only 20%-30%. Glioma is one of the worst prognosis tumors with comprehensive treatment. How to prolong survival time in patients with glioma and improve their quality of life become an urgent problem in the medical field today. Therefore, it is of great significance to identify the prognosis factors of patients with glioma, which will assess the prognosis of patients with glioma and formulate individualized treatment plan.Gliomas are invasive growth, with the surrounding brain tissue boundaries not very clear. Studies indicate that cancer-related inflammation affects many aspects of the neoplastic process by promoting or restraining progression, angiogenesis and metastasis, suppressing antitumor immunity and impacting response to systemic therapies. Neutrophil-lymphocyte ratio (NLR) has been proved to be independent prognostic factor for survival in various solid tumors, including esophageal carcinoma, colorectal carcinoma, hepatocellular carcinoma, gastric cancer, and renal cell carcinoma, and so on. Prognostic nutritional index (PNI), based on serum albumin level and total lymphocyte count, was originally proposed to assess perioperative nutritional status, risk of gastrointestinal surgical and postoperative complications. In the last decades, PNI has been proved to be an independent preoperative prognostic indicator in various tumors, especially in gastrointestinal carcinomas, pancreatic cancer and colorectal cancer. However, researches available regarding NLR, PNI in glioma are limited so far. Therefore, we conducted a retrospective study on glioma, attempting to evaluate the prognostic value of cellular components of the systemic inflammatory response, including the preoperative NLR and PNI for the disease.[Methods]We conducted a retrospective analysis of 80 patients underwent surgical re moval of tumor at the Department of Neurosurgery, Qilu hospital of Shandong University. Patients were included if they underwent radical surgery for pathol ogically proven glioma. Clinicopathological characteristics and laboratory data w ere retrospectively obtained from the patient records. As part of the physical e xaminations, a complete blood count (CBC) was collected in all patients within one week prior to surgery. We recorded the survival time of patients within 5 years. Statistical analysis was done using the Statistical Package for Social Sci ence (SPSS for Windows, version 22.0, SPSS Inc, Chicago, IL) program. Recei ver-operating characteristic curve (ROC), giving consideration to both sensitivity and specificity, was used to calculate the best cutoff point. In the case of RO C value> 0.5, the more close to 1, the better the diagnosis effect is, In the c ase of ROC value<0.5, indicating the diagnosis method doesn’t work complet ely, with no diagnostic value. The chi-square test was used to describe the cor-relation between NLR, PNI and the clinicopathological characteristics. Kaplan Meier-survival analysis was used to construct the survival curve, Log-rank test was used to compare the difference between groups. Cox proportional hazards model was used for multiple factors analysis, P<0.05 representatives statistical significance.[Results]By applying Receiver-operating characteristic analysis, we determined the value of 2.66 for NLR, and 50.43 for PNI as optimal cutoff. Based on the cutoff value of NLR,30 patients were separated into the high NLR group (≥2.66),and 50 patients were separated into the low NLR group (<2.66). Based on the cutoff value of PNI,63 patients were separated into the high PNI group (≥50.43), and 17 patients were separated into the low PNI group (<50.43). Chi-square test showed significant difference between the patients with high NLR and low NLR regarding KPS score (P <0.05); however, no significant difference was identified regarding age, sex, tumor size, postoperative radiation and chemotherapy with NLR (P>0.05). Significant difference between the patients with high PNI and low PNI was found regarding KPS score (P<0.05); No significant difference was identified regarding age, sex, tumor size, postoperative radiation and chemotherapy with PNI (P>0.05). The 3-year OS and 5-year OS for patients with low NLR were 57% vs. 38.5%,10.2% vs. 6.5% for patients with high NLR, respectively. Patients with low preoperative NLR had a significant better prognosis for OS (mean 36 vs.18.3 months, P<0.05) than those with high preoperative NLR. In comparison with the NLR, the 3-year OS and 5-year OS for patients with high PNI were 49.9% vs. 29.4%,7.9% vs. 5.8% for patients with low PNI, respectively. Patients with high preoperative PNI had a significant better prognosis for OS (mean 36 vs. 23.5months, P<0.05) than those with low preoperative PNI. However, COX multivariate analysis demonstrated that preoperative LMR and PNI were not independent prognostic factor for OS in patients with glioma.[Conclusions]As economic and convenient clinical indicators, glioma patients with low preoperative NLR demonstrated a significant better prognosis for OS than those with high preoperative NLR; patients with high preoperative PNI demonstrated a significant better prognosis for OS than those with high preoperative PNI. NLR and PNI value can be used for the preliminary judging the prognosis of glioma patients with surgery, but they were not independent prognostic factor for OS in patients with glioblastoma. |
PDF Full Text Request