A Scoring System Based On Peripheral Blood Test For Predicting Postoperative Recurrence Of WHO Grade Ⅱ Meningioma

PurposeMeningiomas are the most common primary CNS tumors originating from arachnoid cap cells,and WHO grade Ⅱ meningiomas have some degree of malignant tendency.Numerous studies have demonstrated the potential of preoperative hematological indicators to predict clinical outcomes.The purpose of this study was to investigate the predictive value of preoperative hematologic indicators for postoperative recurrence of WHO grade Ⅱ meningiomas and to develop a novel scoring system(NSS)based on hematologic markers to predict the recurrence of WHO grade Ⅱ meningiomas and the progression-free survival(PFS)of patients.MethodsThis study retrospectively analyzed the clinical data of patients with WHO gradeⅡ meningioma who underwent surgical treatment at the First Affiliated Hospital of Zhengzhou University from January 2014 to June 2018.Basic characteristics,preoperative hematological test results,imaging findings,surgical records and postoperative follow-up results were collected for each patient.The optimal cut-off value for each hematological indicator was determined by the receiver operating characteristic curve and the hematological indicators were adjusted to dichotomous variables.Patients were randomly divided into training group and test group in a ratio of 7:3.In the training group,hematological indicators with prognostic value were screened using univariate COX regression and least absolute shrinkage and selection operator COX regression and a hematological risk model(HRM)was constructed.The hematological risk score(HRS)was calculated for each patient and the patients were divided into high-risk and low-risk groups based on the optimal cut-off value of HRM.The predictive accuracy and stability of HRM and NSS were validated in the test group.Patients were divided into different subgroups according to their clinical characteristics for subgroup analysis.Results274 patients with WHO grade Ⅱ meningioma were included in this study and were randomized to the training group(192,70%)and the test group(82,30%).The male to female ratio was 1:1.49 and the median age was 53.8 ± 13.4 years.The preoperative neutrophil-to-lymphocyte ratio,lymphocyte-to-monocyte ratio,platelet-to-lymphocyte ratio,albumin-to-globulin ratio,D-dimer,fibrinogen,and lactate dehydrogenase were associated with PFS.The best cut-off value of HRM was 2.052.The long-term predictive performance of HRM was better.PFS was significantly shorter in patients in the hematological high-risk group than in the low-risk group(P<0.001).Univariate COX regression and multivariate COX regression analysis showed that age,tumor site,tumor size,peritumoral brain edema(PTBE),extent of resection,Ki-67 index,and postoperative radiotherapy were independent risk factors for recurrence of WHO grade Ⅱ meningioma(P<0.05).The score range of NSS based on these clinical prognostic factors and HRS was 240 to 440,and the corrected C indexes of NSS in the training group and the test group were 0.79 and 0.80 respectively.The correction curve shows that NSS had good prognostic performance in postoperative 3-year and 5-year.The Decision Curve Analysis showed that considerable net clinical benefit can be obtained after using NSS.Subgroup analyses showed that HRSs in patients≥51 years old and patients with PTBE were higher than that in patients<51 years old and patients without PTBE,and HRS was an independent risk factor for recurrence of WHO grade Ⅱ meningioma in different subgroups.Kaplan-Meier survival curve showed that PFS of patients in the hematological high-risk group was significantly shorter than that of patients in the low-risk group,regardless of changes in other covariates.In the hematological low-risk group,PFS was shorter in patients with tumor size≥4.2cm,tumor location at skull base,PTBE,STR,and Ki-67≥10%(P<0.05).In the hematological high-risk group,PFS was shorter in patients with tumors located at skull base(P=0.020).Conclusions1.HRM constructed based on hematological indicators was an independent risk factor for recurrence of WHO grade Ⅱ meningioma,and PFS was shorter in patient with high HRS.2.The NSS constructed based on HRS and clinical prognostic factors had good predictive accuracy and stability,and good clinical benefit can be obtained after using this prognostic scoring system.3.HRM is related to patient age and PTBE,and had good predictive stability in different clinical subgroups,which can be combined with each clinical characteristic to further stratify patient management.4.The NSS needs further validation and promotion in prospective studies with large samples.