title: Prognostic value of the preoperative immunological profile in patients with glioblastoma.
abstract: BACKGROUND
  Aim of our study was to determine the predictive impact of certain serum immunological markers on overall survival (OS) in patients with glioblastoma multiforme (GBM).
  
  
  METHODS
  We assayed prospectively values of interleukin 2 (IL-2), immunoglobulin G (IgG), C4, CD3+, CD4+ and CD8+ cells via flow cytometry, enzyme-linked immunosorbent assay (ELISA) and radial immunodiffusion in preoperative sera of adult patients with de novo histologically confirmed supratentorial GBM. Kaplan-Meier method and Cox proportional hazards models were used to assess clinical, laboratory, and treatment prognostic factors for OS.
  
  
  RESULTS
  Twenty-six consecutive patients were identified with a mean age of 59.6 years. Median follow up was 12 months. Lower IL-2 values (<7.97 pg/ml vs. ≥7.97 pg/ml, P = 0.029) und CD4+ counts (<200 cells/μl vs. ≥200 cells/μl, P < 0.001) correlated significantly with a shorter OS. The independent prognostic relevance of CD4 + counts was confirmed by the multivariate analysis (HR = 0.010, 95% CI 0.001-0.226, P = 0.011). Further independent prognostic factors for OS were type of resection (resection vs. biopsy) and administration of radiotherapy (yes/no).
  
  
  CONCLUSIONS
  Preoperative values IL-2 and CD4+ cells in sera may carry a prognostic impact. Novel diagnostic models prior to histopathological confirmation may be used to predict prognosis of patients with GBM. Future studies should investigate whether targeting immune factors, such as CD4+ and IL-2, may improve the prognosis of patients with GBM.
authors.affiliation: Department of Neurosurgery, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53105, Germany ; Department of Neurosurgery, University Hospital of Ioannina, 45500, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Gousias
authors.affiliation: Department of Neurosurgery, University Hospital of Ioannina, 45500, Greece.
authors.forename: Spiridon
authors.initials: S
authors.lastname: Voulgaris
authors.affiliation: Department of Haematology, University Hospital of Ioannina, 45500, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Vartholomatos
authors.affiliation: Department of Rheumatology, University Hospital of Ioannina, 45500, Greece.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Voulgari
authors.affiliation: Department of Neurology, University Hospital of Ioannina, 45500, Greece.
authors.forename: Athanasios P
authors.initials: AP
authors.lastname: Kyritsis
authors.affiliation: Department of Psychiatry, Landschaftsverband Rheinland Klinik, Kaiser-Karl-Ring 20, Bonn, 53111, Germany.
authors.forename: Markella
authors.initials: M
authors.lastname: Markou
keywords: CD4+ cells; IL-2; glioblastoma multiforme; overall survival; serum