Pre-operative hematological markers as predictive factors for Overall Survival and Progression Free Survival in Glioblastomas

Introduction: Several hematological factors, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutrition index (PNI) and albumin-to-globulin ratio (AGR), have been highlighted as systemic worse prognostic parameters for the outcome in gliomas. The aim of this study is to identify some pre- operative routinely blood tests as predictive parameters for the Overall Survival (OS) and Progression Free Survival (PFS) in glioblastoma (GBM). Materials and methods: From January 2013 to April 2019, 124 patients operated for glioblastoma were analyzed. Data were collected regarding age, sex, Karnofsky performance status (KPS), IDH status, the extent of resection (EOR) and adjuvant therapy. The hematological parameters were collected at admission: neutrophils, lympho-cytes and platelets, hemoglobin, lactate dehydrogenase, albumin, NLR, PLR, AGR and PNI. The OS and the PFS were considered as the end-point for the evaluation of the predictive factors. Results: A pre-operative neutrophil count >7×109/L was a worse prognostic factor for OS and PFS at univariate analysis (p=0.004 and p=0.025), as well as hypo-albuminemia. Thrombocytosis, lymphopenia and NLR>4 were associated to a worse OS, at uni- and multivariate analysis, resulting as poor predictive parameters, independently to EOR, the IDH mutation and the adjuvant therapy. Conclusions: Still nowadays there are no sensitive or specific hematological markers which are routinely applied for detecting and monitoring the treatment-response and the prognosis of glioblastoma. In our study, a pre- operative low cost and widely used blood markers, such as NLR, lymphocytes and platelets could be predict-able prognostic factors for the Overall Survival of patients affected by glioblastomas.