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PRETREATMENT NEUTROPHIL-TO-LYMPHOCYTE/MONOCYTE-TO-LYMPHOCYTE RATIO AS PROGNOSTIC BIOMARKERS IN GLIOMA PATIENTS
Introduction, Objectives, Methods, Results, and Conclusion.
Introduction: In the glioma microenvironment, elevations in immune cell ratios are posited to reflect the host’s systemic response to malignancy. Given the dearth in clinically significant molecular markers to predict prognosis, there is potential for peripheral immune cell ratios to serve as low-cost and readily available prognostic markers.
Objectives: This study evaluated the ability for pretreatment peripheral immune cell ratios (Neutrophil-to-Lymphocyte Ratio, NLR, and Monocyte-to-Lymphocyte Ratio, MLR) to predict overall survival (OS) and modified Rankin Scale (mRS) at admission, 6 months and 12 months post-diagnosis. It also explored relationships between immune cell ratios and clinicopathological parameters (tumour location, tumour size, tumour grade, IDH-1 mutation and MGMT promoter methylation status).
Methods: Pretreatment NLR and MLR were analysed retrospectively in 64 glioma patients. OS was evaluated with the Kaplan-meier method. Prognostic factors for OS and mRS were evaluated with univariate and multivariable regression analyses.
Results: Higher pretreatment NLR (>4.7), compared to lower pretreatment NLR (≤ 4.7), predicted higher mean admission mRS (mean 3.31 vs 2.40, p<0.001) and 6-month mRS (mean 3.60 vs 2.44, p=0.02). Higher pretreatment NLR was associated with poor functional outcome (mRS 3-6) at admission (p<0.001) and 6 months (p=0.001). Higher pretreatment MLR (>0.35) predicted poorer OS in glioma patients (median 57.0 ± 6.6 weeks, 95% CI 43.4-70.6, p=0.02). Higher NLR was associated with larger tumour diameter (≥5cm) (p=0.02).
Conclusion: To our knowledge, this was the first study to evaluate the association between immune cell ratios and mRS in glioma patients. This study demonstrated that NLR and MLR can serve as prognostic markers to predict functional outcomes and OS in glioma patients. These findings allow us to identify high-risk patients in need of further treatment and advance understanding of the role of immune cells in glioma pathogenesis.
Keywords (separated by comma on a single line)
NLR, MLR, glioma, prognosis
SHER TING CHIM, PAUL SANFILIPPO, TERENCE J O'BRIEN, KATE A DRUMMOND, MASTURA MONIF