A Novel Scoring System Based on Preoperative Routine Blood Test in Predicting Prognosis of Atypical Meningioma

Abstract

Purpose: The aim of this study was to explore the correlation and clinical significance of preoperative fibrinogen and neutrophil-lymphocyte ratio (F-NLR) scoring system with 3-year progression-free survival (PFS) of patients with atypical meningioma.

Materials and methods: Clinical, pathological, radiological, and laboratory variables were collected to analyze their correlation with 3-year PFS in the training set with 163 patients. Patients were classified by different F-NLR scores (0, 1, or 2). External validation for the predictive value of F-NLR scoring system was performed in the validation set with 105 patients.

Results: Overall, 37.3% (100 of 268) of the enrolled patients were male. The scoring system showed good performance in predicting 3-year PFS (AUC = 0.872, 95%CI = 0.811-0.919, sensitivity = 66.1%, specificity = 93.3%, and Youden index = 0.594). DeLong's test indicated that the AUC of F-NLR scoring system was significantly greater than that of fibrinogen level and NLR (Z = 2.929, P = 0.003; Z = 3.376, P < 0.001). Multivariate Cox analysis revealed that tumor size (HR = 1.39, 95%CI = 1.10-1.76, P = 0.007), tumor location (HR = 3.11, 95%CI = 1.60-6.95, P = 0.001), and F-NLR score (score of 1: HR = 12.78, 95%CI = 3.78-43.08, P < 0.001; score of 2: HR = 44.58, 95%CI = 13.02-152.65, P < 0.001) remained significantly associated with 3-year PFS. The good predictive performance of F-NLR scoring system was also demonstrated in the validation set (AUC = 0.824, 95%CI = 0.738-0.891, sensitivity = 62.5%, specificity = 87.9%, and Youden index = 0.504).

Conclusion: Our study confirmed the correlation and clinical significance of preoperative F-NLR scoring system with 3-year PFS of patients with atypical meningioma. A prospective and large-scale study is required to validate our findings.

Keywords: atypical meningioma; fibrinogen; neutrophil-lymphocyte ratio; prognosis; progression-free survival.

FIGURE 1

Receiver operating characteristic curve analyses comparing neutrophil counts, lymphocyte counts, fibrinogen level, and neutrophil-lymphocyte ratio for predicting patients reaching 3-year progression-free survival in the training set.

FIGURE 2

Receiver operating characteristic curve analyses comparing fibrinogen and neutrophil-lymphocyte ratio scoring system, fibrinogen level, and neutrophil-lymphocyte ratio for predicting patients reaching 3-year progression-free survival in the training set.

FIGURE 3

Kaplan-Meier curve of the 3-year progression-free survival rate in patients with different fibrinogen and neutrophil-lymphocyte ratio score from 0 to 2 in the training set.

FIGURE 4

(A,B) Subgroup analysis of Kaplan-Meier curve of the 3-year progression-free survival rate in patients with different fibrinogen and neutrophil-lymphocyte ratio score from 0 to 2 based on tumor location in the training set. (A) F-NLR score was associated with 3-year PFS in non-skull base tumors, P < 0.001. (B) F-NLR score was associated with 3-year PFS in skull base tumors, P < 0.001. (C,D) Subgroup analysis of Kaplan-Meier curve of the 3-year PFS rate in patients with different F-NLR scores based on extent of resection. (C) F-NLR score was associated with 3-year PFS in patients with Simpson grade I-II resection, P < 0.001. (D) F-NLR score was not associated with 3-year PFS in patients with Simpson grade III-V resection, P = 0.045.

FIGURE 5

The distribution of patients with different F-NLR scores in the recurrence group and non-recurrence group was similar between the training set and the validation set.

FIGURE 6

Receiver operating characteristic curve analyses comparing fibrinogen and neutrophil-lymphocyte ratio scoring system, fibrinogen level, and neutrophil-lymphocyte ratio for predicting patients reaching 3-year progression-free survival in the validation set.