Clinical Study Of Prognostic Factors In Gliomas

Background: Gliomas are common intracranial tumors,their clinical prognosis is poor and therapeutic effect is not satisfactory.The existing methods for classifying gliomas are based on histopathology.However some low-grade gliomas classified by this method have a poor clinical prognosis similar to high-grade gliomas,while some high-grade gliomas have a longer survival time.Therefore,classical histopathology is not effective in guiding the treatment and predicting prognosis of glioma patients.With the in-depth and mature research of molecular markers of glioma,the guideline for the diagnosis and treatment of central nervous system tumors in 2016 has taken molecular biological characteristics as an essential factor for the classification of gliomas.One of the more important molecular markers is the mutation of the isocitrate dehydrogenase(IDH)gene.The importance of the IDH gene mutation is that the IDH gene mutation can provide an objective basis for the classification and grading of glioma,and at the same time it is an important molecular predictive marker of the prognosis of glioma.The adjuvant treatment strategies of gliomas classified by IDH gene mutation include radiotherapy,chemotherapy and chemoradiotherapy.The rational choice of these methods can improve the prognosis of patients with gliomas,and can minimize toxic side effects,thus improving the quality of life of patients.The results of the Cancer Genome Atlas research team have shown that the analysis of the DNA genome methylation levels reveal that there is a subset of gliomas characterized by a high level of systemic inflammation based on isocitrate dehydrogenase(IDH)gene status and methylation levels.In addition,inflammation may play an important role in cancer progression,and it has been reported that the high neutrophil-lymphocyte ratio(NLR)may be suggestive of a poor prognosis for certain malignancies.NLR is a convenient and economical marker for detection,which is a further supplement to clinical decision and prognostic evaluation.Objective: To explore the factors affecting the prognosis of patients with glioma in China;To investigate the relationship between IDH1 gene mutations and NLR,a marker of systemic inflammatory response,and their influence on prognosis in glioma.Methods: In this study,a total of 229 glioma patients were enrolled from XiJing Hospital.After designing a follow-up table involving relevant factors,the data was collected by reviewing the admission medical records and telephone follow-up.The NLR was calculated using preoperative blood routine test results.Immunohistochemical staining was used to detect IDH1 mutations,and retrospective analysis was performed on the collected glioma patients.We used SPSS19.0 statistical software for statistical analysis.We analyzed the correlation between NLR and IDH1,and used the survival analysis method to study the prognostic of each factor predicting survival in patients with glioma.Results: Through analysis of the follow-up results of age,Karnofsky Performance Status(KPS)score,and survival time of patients with gliomas.We found that age>63 years(p=0.009,Hazard Ratio,HR=2.408)was a risk factor of overall survival in patients with high-grade glioma,and KPS score?70(p=0.001,HR=2.556)might be a risk factor affecting the overall survival of patients with glioma.Radiation therapy(p=0.004,HR=0.378),chemotherapy,concurrent chemoradiotherapy(p=0.001,HR=0.138)and adjuvant chemotherapy after radiotherapy(p=0.001,HR=0.299)were protective factors to improve the prognosis of glioma patients and had statistical significance in prolonging their survival time of patients.In the comparison of the effect of different chemotherapeutic drugs on survival time,Temozolomide(TMZ)(p=0.768,HR=0.893)had some advantages in affecting the survival time of glioma patients,but the difference was not statistically significant.IDH1 mutation(p=0.001,HR=0.301)was a protective factor to prolong the survival time of gliomas.Especially,high-grade gliomas with NLR>4(p=0.001,HR=2.671)before treatment was a risk factor for prognosis,and its predictive effect on prognosis was even more pronounced in patients with glioblastoma.IDH1 mutations might have a certain correlation with preoperative NLR in patients with glioma(r=-0.290,p=0.001).Conclusions: Younger age,NLR?4,KPS score>70 and IDH1 mutation may indicate better prognosis for glioma.Postoperative radiotherapy,chemotherapy and concurrent chemoradiotherapy are the factors which can significantly improve the overall survival time of patients with glioma.IDH1 gene mutations suggest a good prognosis for high-grade gliomas.High NLR before treatment suggests a poor prognosis for glioblastomas;Metabolism-associated IDH1 is associated with the immune response-related marker NLR,suggesting that interaction between these two factors plays a role in the progress of tumor.