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Original Article

Prognostic significance of neutrophil‑to‑

lymphocyte ratio in glioblastoma

2
1,2
George A. Alexiou , Evrysthenis Vartholomatos , Panagiota Zagorianakou , Spyridon Voulgaris 1
1
1 Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Ioannina, Greece.
2 Neurosurgical Institute, University of Ioannina, 45500 Ioannina, Ioannina, Greece
ABSTRA CT

Aim: The neutrophil‑to‑lymphocyte ratio (NLR) has prognostic value in patients with a variety of cancers. The purpose of this study
was to investigate the prognostic value of NLR in patients with glioblastoma. Methods: A prospective study was conducted on
patients receiving surgery for glioblastoma. Preoperative NLR was recorded and correlated with other prognostic factors and survival.
Results: Fifty‑one patients were included in the study. The mean NLR ratio was 6.7 ± 4.6. Using receiver operating characteristic
curve analysis, an NLR cut‑off value of 4.7 was determined to best predict survival. Patients with NLR ratios exceeding 4.7 differed
significantly from those with NLR ratios ≤ 4.7 and were associated with reduced survival. Patients with gross total tumor excision
had a median survival of 18 months, whereas the median survival time was 11 months in patients with subtotal tumor excision.
No significant difference in survival was observed with respect to patient age, gender, Karnofsky performance status, or tumor
location. Using multivariate analysis, NLR and extent of tumor resection were identified as factors with independent prognostic
power. Conclusion: Neutrophil‑to‑lymphocyte ratio is an inexpensive, widely available biomarker of glioblastoma aggressiveness
and should be used alongside current glioblastoma prognostic factors.

Key words: Glioblastoma, neutrophil‑lymphocyte ratio, prognosis

INTRODUCTION best of our knowledge, only one study has assessed
the role of NLR in glioblastoma patients. [14] In this
Glioblastoma is by far the most common type of primary study, we aimed to assess the prognostic value of
brain tumor that occurs in adults. This devastating NLR and correlate it with other prognostic factors of
disease is usually incurable and, despite aggressive glioblastoma.
treatment, the median survival time remains in the
range of 15 months. Cancer‑associated inflammation METHODS
[1]
has been correlated with outcome in patients with
cancer. [2‑4] Among the various inflammation markers, Study population
the neutrophil‑to‑lymphocyte ratio (NLR) has been We prospectively studied patients who received
examined in a variety of cancers and has been found surgery for glioblastoma in our institute between
to be elevated in patients with more advanced or March 2007 and September 2013. Patients were
aggressive disease. [5‑8] The exact mechanisms by which included if they had full blood count results at first
neutrophilia is induced by tumors is unclear. [9,10] The presentation, before any treatment. The extent of
secretion of angiogenesis factors and cytokines has been resection was determined by comparing magnetic
implicated to play a role in neutrophilia induction. [11,12] resonance imaging (MRI) scans obtained before surgery
In gliomas, lymphocyte infltration around the tumor with those obtained within the 1 month after surgery.
st
has been associated with a better prognosis. [13] To the Clinical variables that were analyzed included age,
sex, and preoperative Karnofsky performance status
Access this article online score (KPS). Radiological variables included tumor
Quick Response Code: lateralization, location and volume. Tumor volumes
Website: were approximated from preoperative, postgadolinium
www.nnjournal.net
T1‑weighted MRI using a modified ellipsoid volume
DOI: equation (radius × radius × radius )/2. [15] All
x
z
y
10.4103/2347-8659.143666 patients received postoperative radiotherapy with
temozolomide, followed by temozolomide chemotherapy
Corresponding Author: Dr. George A. Alexiou, Department of Neurosurgery, University Hospital of Ioannina,
P.O. Box 103, Neochoropoulo, 45500 Ioannina, Ioannina, Greece. E-mail: alexiougr@gmail.com

Neuroimmunol Neuroinflammation | Volume 1 | Issue 3 | December 2014 131