Progenostic value of preoperative hematological markers combined with molecular pathology in patients with diffuse gliomas
Progenostic value of preoperative hematological markers combined with molecular pathology in patients with diffuse gliomas
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术前血液学标志物联合分子病理学对弥漫性胶质瘤患者的预后价值
DOI：
10.18632/aging.102186
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发表时间：
2019-08-31
期刊：
影响因子：
5.2
通讯作者：
Wang, Wei-Wei
中科院分区：
文献类型：
--
作者：
Zhang, Zhen-Yu;Zhan, Yun-Bo;Wang, Wei-Wei
浸润性胶质瘤患者的临床预后预测具有挑战性。尽管术前血液学标志物已被提出作为神经胶质瘤和其他癌症生存的预测因子，但需要将这些数据与其他相关临床变量联合收割机相结合的系统研究来提高预后准确性和患者结局。我们研究了术前血液学标志物单独和结合分子病理学对592例II-IV级弥漫性胶质瘤患者生存的预后价值。单变量分析显示，嗜中性粒细胞与淋巴细胞比率（NLR）、血小板与淋巴细胞比率（PLR）和单核细胞与淋巴细胞比率（MLR）升高以及白蛋白与球蛋白比率（AGR）降低均预示II/III级胶质瘤预后不良。基于IDH突变、TERT启动子突变和1 p/19 q共缺失的肿瘤状态的多变量分析显示，在低级别胶质瘤中，高NLR预测三阴性、仅IDH突变、仅TERT突变以及IDH和TERT突变组的生存率较差。NLR是IV级胶质瘤的独立预后因素。因此，我们提出了一个基于IDH和TERT启动子突变，1 p/19 q共缺失和NLR的弥漫性胶质瘤的预后模型。该模型将低级别胶质瘤分为九个亚组，这些亚组可以根据生存预测组合成四个主要风险组。
The prediction of clinical outcome for patients with infiltrative gliomas is challenging. Although preoperative hematological markers have been proposed as predictors of survival in glioma and other cancers, systematic investigations that combine these data with other relevant clinical variables are needed to improve prognostic accuracy and patient outcomes. We investigated the prognostic value of preoperative hematological markers, alone and in combination with molecular pathology, for the survival of 592 patients with Grade II-IV diffuse gliomas. On univariate analysis, increased neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), and decreased albumin-to-globulin ratio (AGR), all predicted poor prognosis in Grade II/III gliomas. Multivariate analysis incorporating tumor status based on the presence of IDH mutations, TERT promoter mutations, and 1p/19q codeletion showed that in lower-grade gliomas, high NLR predicted poorer survival for the triple-negative, IDH mutation only, TERT mutation only, and IDH and TERT mutation groups. NLR was an independent prognostic factor in Grade IV glioma. We therefore propose a prognostic model for diffuse gliomas based on the presence of IDH and TERT promoter mutations, 1p/19q codeletion, and NLR. This model classifies lower-grade gliomas into nine subgroups that can be combined into four main risk groups based on survival projections.