Association of preoperative levels of selected blood inflammatory markers with prognosis in gliomas

Abstract

Background: Red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), and platelet count (PLT) routinely tested as part of the complete blood count are indicative of systemic inflammation. The prognostic significance of NLR and PLT in cancer was demonstrated in many studies while the role of RDW has been hardly investigated. The present study aimed to assess the association of RDW, NLR, and PLT with survival and tumor grade in glioma patients.

Methods: Clinical data from 178 patients with primary gliomas treated in a single institution were retrospectively analyzed. Receiver operating characteristic curves for cutoff value determination, Kaplan-Meier survival analysis, various bivariate tests, and univariate and multivariate Cox regression analyses were performed.

Results: Patients with high RDW (≥13.95) and NLR (≥4) levels had worse overall survival (OS) (Wilcoxon test, P<0.026 and P<0.003, respectively) while the effect of thrombocytosis (≥400×10⁹/L) on prognosis was not significant. Besides, a strong association between RDW and NLR was found (Spearman's rho =0.230, P<0.02; χ²=8.887, P<0.03; Mann-Whitney U-test, P<0.017). Moreover, RDW and NLR were significantly associated with tumor grade. In univariate Cox analysis, elevated NLR (hazard ratio, HR 1.385; confidence interval, CI 1.020-1.881, P<0.037), older age (HR 0.452, CI 0.329-0.621, P<0), and higher tumor grade (HR 1.624, CI 1.187-2.223, P<0.002) were associated with poor outcomes. In the multivariate analysis, tumor grade, age, and Karnofsky performance score were identified as being independently prognostic for OS.

Conclusion: Preoperative NLR and RDW values can help to evaluate disease progression and outcomes in patients with gliomas, thereby contributing to patient follow-up optimization.

Keywords: glioma; neutrophil–lymphocyte ratio; platelet; red cell distribution width; survival; tumor grade.

Figure 1

ROC curves for (A) age (AUC 0.719, 95% CI 0.624–0.814, P<0.015) and (B) RDW (AUC 0.720, 95% CI 0.592–0.847, P<0.015). Abbreviations: ROC, receiver operating characteristic; AUC, area under curve; CI, confidence interval; RDW, red cell distribution width.

Figure 2

Overall survival Kaplan–Meier curves stratified by (A) RDW or (B) NLR. Abbreviations: RDW, red cell distribution width; NLR, neutrophil–lymphocyte ratio.