The Value Of Preoperative Hematologic Inflammatory Markers In Prognostic Of Glioma Patients

Objective:To investigate the clinical characteristics and clinical prognostic factors of glioma patients,and to explore the predictive value pre-operative hematologic inflammatory markers in the clinical prognosis of glioma patients.Methods:This study was a retrospective analysis.180 patients with glioma were enrolled in the present study in Tianjin Cancer Hospital from January 2013 to January2018.The Variables were including gender,age,World Health Organization（WHO）grade,tumor size,tumor cystic change,Tumor range of resection and tumor recurrence time,and the counts of neutrophils,lymphocytes,monocytes and platelet within preoperative one week.Data analysis used SPSS 19.0 statistical software,the measurement data were described by M(P₂₅,P₇₅),and the count data were expressed with number/percentage.The receiver operating characteristic curve（ROC）was used to determine the optimal cutoff value of neutrophil-to-lymphocyte ratio（NLR）,monocyte-to-lymphocyte ratio（MLR）and platelet-to-lymphocyte ratio（PLR）,and based on the optimal cutoff value to divide groups.The clinical features grouped by NLR,MLR and PLR were analyzed by chi-square test.The Kaplan-Meier and Log-rank methods were used to analyze the survival.The independent prognostic factors were evaluated by multivariate Cox regression analyses.Pearson,s correlation coefficient tested the correlations among these hematologic inflammatory markers.P value<0.05 is statistically significant.Result:The blood biomarkers were divided into two groups according to WHO grade.Neutrophil,lymphocyte,platelet and MLR after comparing were significant difference（P<0.05）,while monocyte and PLR were no difference（P>0.05）.The areas under the ROC curves of NLR,MLR and PLR were 0.673,0.538 and0.538,respectively.The optimal cutoff value of there were 0.33（sensitivity 31.3,specificity 80.2）and 133.38（sensitivity 47.5%,specificity 64.2%）,respectively.Among 180 glioma patients,57.8%were male and 42.2%were female;66.2%were over 50 years old;51.1%were WHO IV grade patients;50%tumor size more than 3 cm;18.3%had cystic change.There was only significant difference in WHO grade or gender grouped by NLR（P=0.001）or PLR（P=0.035）.Gender,WHO grade and tumor cystic changes were significant differences grouped by MLR（P<0.05）.Among 154 patients,45.6%had recurrence less than one year.The recurrence rate was 31.7%and 55.4%in low NLR and high NLR group,respectively.High NLR patients were prone to recurrence.And only NLR group had significant difference in the time of tumor recurrence（P=0.002）.According to Kaplan-Meier method,the median overall survival time（OS）of high NLR group was 16.8 months and low NLR group was 40.5 months.The median OS was 14.8 and 24.6 months in high and low MLR group,respectively.The difference was statistically significant（P<0.05）.The median OS was 19.7 and 23.9 months in the high and low PLR group,respectively.there was no significant difference（P>0.05）.Univariate analysis showed that age（>50 years）,WHO IV glioma,NLR（>1.90）and MLR（>0.33）were adverse factors affecting survival（P>0.05）.Used Cox regression model analysis showed that age（>50 years old）（HR 1.704;95%CI,1.013-2.866;P=0.045）,GBMs（HR 3.129;95%CI,1.884-5.196;P<0.001）,NLR（>1.90）（HR 1.725;95%CI,1.042-2.853）;P=0.034)were independent risk factors for patients.There was no significant difference in MLR（P>0.05）.According to Kaplan-Meier method,the median recurrence time of high NLR group was 10.3 months,while the low NLR group was 28.8 months.The difference was significant（P=0.002）.The recurrence time of high NLR group was significantly shorter than low NLR group.Pearson,s correlation coefficient test showed that NLR was correlated with MLR（r=0.62）and PLR（r=0.59）（P<0.001）,and the correlation between NLR and MLR was stronger than that between NLR and PLR.Conclusion:High levels of NLR and MLR are closely related to poor prognosis of glioma patients based on preoperative hematological inflammation markers.NLR is an independent risk factor for survival and prognosis of glioma patients,and is also closely related to recurrence rate of glioma.