Pre-treatment neutrophil-to-lymphocyte ratio is associated with neutrophil and T-cell infiltration and predicts clinical outcome in patients with glioblastoma.
BACKGROUND
Markers of systemic inflammation are correlated with patient survival in various cancers. The prognostic value of neutrophil-to-lymphocyte ratio (NLR) was compared with that of platelet-to-lymphocyte ratio (PLR) in patients with glioblastoma. The association of NLR with neutrophil and T- cell infiltration was also explored.


METHODS
A total of 152 patients with glioblastoma were retrospectively analyzed. Clinical information was obtained from electronic medical records. Kaplan-Meier analysis and the Cox proportional hazards models were used to examine the survival function of pre-treatment NLR and PLR in these glioblastoma patients. Neutrophil and CD3(+) T-cell infiltration was assessed by immunohistochemical staining of tissue microarray cores from glioblastomas.


RESULTS
Pre-treatment NLR levels were significantly correlated with overall survival (OS) in glioblastoma patients (multivariate hazard ratio =1.050; 95% confidence interval, 1.003-1.100; P = 0.037). Despite the correlation between NLR and PLR (R = 0.509, P < 0.001), NLR was superior to PLR as a prognostic factor. High pre-treatment NLR (≥4 versus < 4) was significantly associated with high neutrophil infiltration and low CD3(+) T-cell infiltration into tumors, and predicted poor OS (mean, 10.6 vs. 17.9 months, P < 0.001).


CONCLUSIONS
Pre-treatment NLR is of prognostic significance independent of MGMT status and is superior to PLR as a prognostic factor. Our results demonstrate a correlation between elevated peripheral blood NLR levels and increased tumor neutrophil infiltration/decreased CD3(+) T-cell infiltration.
Department of Neurosurgery, The First Hospital of China Medical University, Nanjing Street 155, Heping District, Shenyang, 110001, China. hansheng2001_x@aliyun.com.
Sheng
S
Han
Department of Neurosurgery, The First Hospital of China Medical University, Nanjing Street 155, Heping District, Shenyang, 110001, China. 1134788065@qq.com.
Yang
Y
Liu
Department of Pathology, China Medical University, Shenyang, 110001, China. qingchangli@yahoo.com.
Qingchang
Q
Li
Department of Neurosurgery, The First Hospital of China Medical University, Nanjing Street 155, Heping District, Shenyang, 110001, China. 80682749@qq.com.
Zhonghua
Z
Li
Department of Neurosurgery, The First Hospital of China Medical University, Nanjing Street 155, Heping District, Shenyang, 110001, China. 814597256@qq.com.
Haipei
H
Hou
Department of Neurosurgery, The First Hospital of China Medical University, Nanjing Street 155, Heping District, Shenyang, 110001, China. cmuwuanhua@aliyun.com.
Anhua
A
Wu
D000328:Adult; D000368:Aged; D015415:Biomarkers; D001772:Blood Cell Count; D001792:Blood Platelets / Q000473:pathology*; D001932:Brain Neoplasms / Q000473:pathology*; D017252:CD3 Complex / Q000378:metabolism*; D002465:Cell Movement; D005909:Glioblastoma / Q000473:pathology*; D006801:Humans; D007249:Inflammation; D016246:Lymphocytes, Tumor-Infiltrating / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000473:pathology*
D015415:Biomarkers; D017252:CD3 Complex