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. 2020 Jul 14:12:5793-5802.
doi: 10.2147/CMAR.S260695. eCollection 2020.

Predicting Individual Prognosis and Grade of Patients with Glioma Based on Preoperative Eosinophil and Neutrophil-to-Lymphocyte Ratio

Xu Zhang  1   2 , Can Li  1   2 , Lifei Xiao  1   2 , Caibin Gao  1   2 , Wei Zhao  1   2 , Maolin Yang  1   2 , Tao Sun  1   2 , Feng Wang  1   2
Affiliations

Predicting Individual Prognosis and Grade of Patients with Glioma Based on Preoperative Eosinophil and Neutrophil-to-Lymphocyte Ratio

Xu Zhang et al. Cancer Manag Res. .

Abstract

Purpose: Eosinophils are proven to play a role in the prognosis of some malignant-tumors. The prognostic value of eosinophils in glioma patients is, however, scarcely reported. The authors of this article have designed a novel prognostic indicator based on eosinophils and the neutrophil-to-lymphocyte ratio (NLR), named ENS, to predict the survival of patients with glioma.

Methods: A retrospective study was conducted on 217 glioma patients. The cut-off values for eosinophil, NLR, and other clinical variables were determined by the receiver operating characteristic (ROC) curve analysis. Patients with both low eosinophil count (<0.08 ×109/L) and high NLR (≥1.70) were given a score of 2. Those with one or neither got a score of 1 or 0, respectively. The nomogram was based on ENS and several other clinical variables, its performance was determined by the concordance index (c-index).

Results: Our results showed that ENS is an independent prognostic indicator for overall survival (OS). The three-year OS rates for low-grade glioma patients (LGGs) were 84.0%, 69.0%, and 46.4% for ENS=0, ENS=1, and ENS=2, respectively (P=0.014). The three-year OS incidence for LGGs stratified into eosinophils count ≥0.08×109/L and<0.08×109/L subgroups were 88.1% and 80.0%, respectively (P=0.043). ENS was positively correlated with glioma grade (r=0.311, P<0.001). The c-index for OS prognosis was 0.80 using this nomogram in LGGs.

Conclusion: Preoperative ENS can predict OS to some extent for LGGs and can increase prognostic accuracy for individual OS in LGGs postoperatively when incorporating other clinical variables compose a nomogram.

Keywords: eosinophil; low-grade glioma; neutrophil-to-lymphocyte ratio; nomogram; prognosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
The correlations between eosinophil, neutrophil, lymphocyte count, ENS, and glioma grade. (A) The diversity of eosinophil count in different glioma grades. (B) The variety of neutrophil count in different glioma grades. (C) Distribution of lymphocyte count in low-grade and high-grade glioma patients. (D) Distribution of ENS in low and high-grade glioma patients.
Figure 2
Figure 2
Kaplan-Meier survival curves for OS (overall survival) according to preoperative (A) Eo (eosinophils), (C) NLR, (E) ENS in patients with low-grade glioma. Kaplan-Meier survival curves for OS according to preoperative (B) Eo (eosinophils), (D) NLR, (F) ENS in patients with high-grade glioma.
Figure 3
Figure 3
Nomogram and calibration curve. (A) Nomogram for OS prediction of low-grade glioma patients. Drawing a vertical line from each factor to the point score. A total points score is calculated when adding the points from all elements, drawing a vertical line to its axis, the 3-year and 5-year OS probabilities could be known. (B) The calibration curve to predict 3-year OS. The gray line indicates the ideal prediction, and the black line represents the performance of the nomogram. (C) The calibration curve for 5-year OS prediction.
See this image and copyright information in PMC

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