Neutrophilia and post-radiation thrombocytopenia predict for poor prognosis in radiation-treated glioma patients.

Autor:	Hsu EJ; Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, United States., Thomas J; Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, United States., Maher EA; Department of Internal Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, TX, United States.; Department of Neurology, UT Southwestern Medical Center, Dallas, TX, United States., Youssef M; Department of Neurology, UT Southwestern Medical Center, Dallas, TX, United States., Timmerman RD; Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, United States., Wardak Z; Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, United States., Lee M; Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States., Dan TD; Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, United States., Patel TR; Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, United States., Vo DT; Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in oncology [Front Oncol] 2022 Sep 09; Vol. 12, pp. 1000280. Date of Electronic Publication: 2022 Sep 09 (Print Publication: 2022).
DOI:	10.3389/fonc.2022.1000280
Abstrakt:	Introduction: Poor outcomes in glioma patients indicate a need to determine prognostic indicators of survival to better guide patient specific treatment options. While preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) have been suggested as prognostic systemic inflammation markers, the impact of post-radiation changes in these cell types is unclear. We sought to identify which hematologic cell measurements before, during, or after radiation predicted for patient survival. Methods: A cohort of 182 patients with pathologically confirmed gliomas treated at our institution was retrospectively reviewed. Patient blood samples were collected within one month before, during, or within 3 months after radiation for quantification of hematologic cell counts, for which failure patterns were evaluated. Multivariable cox proportional hazards analysis for overall survival (OS) and progression-free survival (PFS) was performed to control for patient variables. Results: Multivariable analysis identified pre-radiation NLR > 4.0 (Hazard ratio = 1.847, p = 0.0039) and neutrophilia prior to (Hazard ratio = 1.706, p = 0.0185), during (Hazard ratio = 1.641, p = 0.0277), or after (Hazard ratio = 1.517, p = 0.0879) radiation as significant predictors of worse OS, with similar results for PFS. Post-radiation PLR > 200 (Hazard ratio = 0.587, p = 0.0062) and a percent increase in platelets after radiation (Hazard ratio = 0.387, p = 0.0077) were also associated with improved OS. Patients receiving more than 15 fractions of radiation exhibited greater post-radiation decreases in neutrophil and platelet counts than those receiving fewer. Patients receiving dexamethasone during radiation exhibited greater increases in neutrophil counts than those not receiving steroids. Lymphopenia, changes in lymphocyte counts, monocytosis, MLR, and changes in monocyte counts did not impact patient survival. Conclusion: Neutrophilia at any time interval surrounding radiotherapy, pre-radiation NLR, and post-radiation thrombocytopenia, but not lymphocytes or monocytes, are predictors of poor patient survival in glioma patients. Competing Interests: Author RT is on the board of directors for TRIO corporation, TMIT corporation, and Reflexion. All do not relate to the subject of this study. Author DV has research funding from AstraZeneca. All do not relate to the subject of this study. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Hsu, Thomas, Maher, Youssef, Timmerman, Wardak, Lee, Dan, Patel and Vo.)
Databáze:	MEDLINE
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