O10.09 * REDUCTION IN NEUTROPHIL-LYMPHOCYTE RATIO DURING INITIAL CONCURRENT CHEMORADIOTHERAPY IS PROGNOSTIC FOR SURVIVAL OF GLIOBLASTOMA PATIENTS
Bibliographic record
Abstract
INTRODUCTION: Elevated baseline neutrophil-lymphocyte ratio (NLR) has been associated with poorer outcome in multiple tumour sites. In the context of glioblastoma (GBM), elevated NLR prior to any initial therapy, including surgery or corticosteroids, or prior to second surgery for recurrent disease predicted worse outcome. The aim of this retrospective cohort study was to assess if change in NLR during initial focal radiotherapy (RT) and concurrent temozolomide (TMZ) predicted outcome in newly diagnosed GBM patients. METHODS: A retrospective chart review was performed for patients treated concurrently with TMZ and RT, at our tertiary referral centre between Jan 2004 and Sept 2010, for histologically confirmed GBM. Age, baseline ECOG performance status (ECOG-PS) and extent of surgery were recorded. Baseline NLR, change in NLR, and time-weighted mean dexamethasone dose (TWMdex) were collected between 2 weeks prior to commencing RT and 10 weeks following the start of RT. Overall survival (OS) was calculated using Kaplan Meier method. Univariate (UVA) and multivariable (MVA) analyses using cox proportional hazard models evaluated variables associated with OS, accounting for colinearity of variables. RESULTS: There were 394 patients who met eligibility and were included in the final analysis. Median age was 54 (range 18-73). With median follow up of 15.2 months (range 1.6-134.6), OS was 66.4% (CI 61.4-70.7) and 31.1% (CI 26.5-35.8) at 1 and 2 years respectively. Median baseline dexamethasone dose was 8 mg (0-30 mg) and median TWMdex dose was 4.94 mg (0.0 -27.4 mg). On UVA, older age (HR 1.034, p <0.0001) and ECOG-PS>2 (HR 1.076, p < 0.001) were associated with shorter survival whereas baseline NLR below the median of 7.5 (HR 0.628, p < 0.0001) and decrease in NLR during treatment (HR 0.644, p < 0.0001) were associated with better survival. On MVA, decrease in NLR remained significantly prognostic for OS (HR 0.763, p = 0.02; CI 0.603 - 0.964) in addition to age (HR 1.032, p < 0.001; CI 1.018-1.045), TWMdex (HR 1.039, p = 0.002; CI 1.014-1.065) and ECOG-PS (HR 0.593, p = 0.008; CI 0.430-0.873). Although, baseline NLR was no longer statistically significant (HR 0.814, p = 0.09; CI 0.641 - 1.032), patients with low baseline NLR and further reduction in NLR during treatment had significantly longer survival (p < 0.0001). The association between change in NLR and change in dexamethasone dose over time was weak (r = 0.22). CONCLUSION: In patients with newly diagnosed glioblastoma, any reduction in neutrophil-lymphocyte ratio during initial concurrent chemoradiotherapy was an independent prognostic factor for longer survival, accounting for other prognostic factors including dexamethasone dose. Patients with low baseline NLR and further reduction in NLR during treatment had the best prognosis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".