Neutrophils and lymphocytes ratio as a prognostic marker in glioblastoma
PH-0360
Abstract
Neutrophils and lymphocytes ratio as a prognostic marker in glioblastoma
Authors: Kaidar-person|, Orit(1)*[orit.Person@gmail.Com];Ben-zvi|, Eyal(2);Tzuk-shina|, Tzahala(2);
(1)Rambam Health Care Campus - Faculty of Medicine, Oncology Institute, Haifa, Israel;(2)Rambam Medical Center, Oncology Institute, Haifa, Israel;
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Purpose or Objective
High grade gliomas (HGG), mainly Glioblastoma (GB) are the most common primary brain tumor in adults. The standard treatment after maximal safe resection includes radiation therapy with chemotherapy (CRT) followed by maintenance of such chemotherapy (TMZ). Evidently, this tri-modally treatment resulted in 14.6 months’ median survival with less than 10% of patients alive at 5-years. Recent years have shown an advancement in the understanding of the relationship between tumors and the patient’s immune system. The current study was to evaluate the ratio between neutrophils and lymphocytes in the peripheral blood (NLR) at pre-defined time points, as a prognostic marker for long term survival in HGG patients.
Material and Methods
After ethics committee approval, a retrospective review of the medical records of consecutive HGG patients treated between 2005-2017 was conducted. The data collected included demographic, and disease/treatment related features and the NLR at 3 different time points [pre-surgery (A), pre-CRT (B), pre-adjuvant TMZ (C)] was calculated. Statistical analysis included receiver operating characteristic (ROC), Mann-Whitney and Pearson chi-square tests. Kaplan Meier was used for survival outcome and compared using the Log-rank test.
Results
A total of 277 patients were included, median age 59 years (range 23-80), 88% had GB, 65% had gross total resection (GTR), 22% had biopsy only. Median overall survival was 17 months. A value of NLR > 3.7 at B and C points was identified as indicators for shorter survival. A statistical relation was found between NLR < 3.7 at these points and favorable prognostic factors such as younger age, less comorbidities and less steroids use.
Conclusion
A NLR of less than 3.7, measured at two time points (between the surgery and CRT and between CRT to the adjuvant TMZ) were found to be independent significant prognostic factors for longer survival. More studies are needed to understand this relationship, and the significance of the level of the lymphocytes in peripheral blood in patients with HGG who are treated with a tri-modality approach.