The Correlation Between Blood Biomarkers And Prognosis Of Glioma And Establishment Of Prediction Model

Objective:Recently more and more researches suggested that preoperative inflammation,nutrition,angiogenesis and blood coagulation function are associated with the occurrence,progression and metastasis in many malignancies.The purpose of the study was to evaluate the correlation between the preoperative systemic immune-inflammation index(SII),prognostic nutrition index(PNI),fibrinogen-to-platelet ratio(FPR)and the clinicopathological factors in patients with glioma,and to investigate the clinical significance and application value of these blood biomarkers in the prognosis of glioma,so as to provide important reference for clinical individualized treatment for glioma patients.Materials and Methods:Patients who underwent brain tumor resection in Qi Lu Hospital of Shandong University between January 2012 and December 2016 were collected in this study.The clinicopathological data of the patients were collected,including the preoperative blood test results and the prognosis of the patients,and the correlation between the preoperative blood markers and the prognosis of the patients with glioma was analyzed.The optimal cut-off points and prognostic values of SII,PNI,and FPR were assessed by X-tile software.According to the cut-off values,glioma patients were divided into high groups and low groups,and the correlation between each group and clinicopathological characteristics was compared.Overall survival(OS)of these patients was estimated by Kaplan-Meier analyses.Univariate and multivariate Cox regression analyses were performed to evaluate the relationship between OS and prognostic variables in patients with glioma.R software was used to develop nomograms with all the independent prognostic factors included,and its predictive efficacy was determined by Harrell’s concordance index(C-index).Results:(1).A total of 406 patients with glioma who under brain tumor resection were retrospectively enrolled in this study.(2).The optimal cut-off values for preoperative SII,PNI and FPR were 695.9,48.5,10.5 respectively.(3).Preoperative SII level was significantly correlated with age(P=0.022),tumor size(P=0.009),pathological grade(P<0.001).Preoperative PNI level was significantly association with gender(P=0.005),age(P<0.001),pathological grade(P=0.003).Inaddition,preoperative FPR level was significantly correlated with gender(P<0.015),age(P<0.001),tumor location(P=0.007),pathological grade(P<0.001).(4).The Kaplan-Meier survival analyses followed by log-rank tests demonstrated that high SII,low PNI and high FPR were association with poor OS of patients with glioma.The subsequent multivariate analysis indicated that age(HR=1.947,P<0.001),pathological grade(HR=0.185,P<0.001),extent of resection(HR=2.076,P<0.001),adjuvant therapy(HR=0.402,P<0.001),and preoperative SII≥ 695.5(HR=1.623,P=0.028)were independent prognostic factors.The nomogram including these independent prognostic factorsexhibited a good accuracy for predicting the survival rate of patients with glioma,with a C-index of 0.783.Conclusion:In this study,by jointly evaluating the effects of inflammatory response,nutritional status and coagulation function on the prognosis of glioma patients before surgery,it was proved that SII level reflecting the preoperative inflammatory status of patientswas an independent prognostic factor for glioma patients.The establishment of nomograms based on independent prognostic factors can be used to predict the individual prognosis of glioma patients more accurately and to carry out individualized treatment.