4P Prognostic value of systemic inflammatory markers in GBM: Multicenter retrospective study

Gliomas are brain tumors the most common being glioblastoma (GBM). GBM treatment is not curative and even patients who respond to initial treatment will recur. Systemic inflammatory markers are related to tumor growth and tumor recurrence. High neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), prognostic nutritional index (PNI), systemic immune-inflammation index (SII) and systemic inflammatory response index (SIRI) are established prognostic factors in some solid tumors. This study aims to evaluate the correlation of these markers with the prognosis of patients with GBM. The clinical data of patients from four centers with GBM diagnosed from Jan 2018 to Jan 2022 were analyzed retrospectively. ROC curves were used to determine cut-offs for NLR, PLR, MLR, SIRI and Sil in each phase of treatment. Kaplan-Meier curves were implemented for variables that were close to the 70% AUC criterion. Significance was considered for p<0.05. A total of 184 patients were included in the analysis, most were females and <65 years old at diagnosis. Most patients were treated with STUP as 1st line. Prevalence of therapy with corticosteroids increased along treatment phases. Median OS was 15 months, median of PFS after 1st-line and 2nd-line treatment was 6 months. PNI (p < 0.001), MLR (p=0.002) and Sil (p=0.005) were significantly lower after 1st-line or 2nd-line treatments when compared with the phase before treatment. After implementing ROC curves none of the parameters filled the 70% AUC criterion. However, after examining the results, SIRI after 1st-line treatment and NLR after 2nd-line treatment for OS were the parameters that were most close to that criterion. Hence, we established as cut-offs, SIRI after 1st-line treatment ≥ 1292.86 and NLR after 2nd-line treatment ≥ 2.58. Kaplan-Meier survival function results show that patients above the established criteria of SIRI and NLR have low OS, p=0.009 and p=0.002, respectively. Post-treatment the ratios NLR and SIRI were associated with worse OS. Steroids did not influence the results. The retrospective study design limits the interpretation. A longer follow-up time and a larger sample size are needed to support these findings.