The clinical relevance of immune peripheral status and its relation to neuroradiological findings in newly diagnosed glioblastomas.

Background: High-grade gliomas are the most frequent and deadliest type of primary brain tumors in adults; despite the significant advances in understanding tumor biology, life expectancy of these patients is still limited. The aim of our study was to analyse blood cells counts and ratios as systemic inflammatory markers in newly diagnosed glioblastoma, to correlate these data with the radiological parameters and to identify their role as prognostic factors. Materials and methods: A retrospective analysis was performed in 112 patients who underwent surgery for glioblastoma between 2016 and 2021. MRI for radiological features was available in all patients. Preoperative blood tests (neutrophils N, lymphocytes L, monocytes M, platelets PLT) were available in 105 patients. Inflammatory markers/ratios (NLR, LMR and PLR) were calculated. RResults: Significant cut-offs for survival in inflammatory ratios were identified. Significant predictors for survival in Cox regression analysis were NLR > 2.3, LMR < 3 and high platelets counts. We then evaluated relationship with radiological parameters: midline location was statistically significantly correlated with higher N and PLT levels as well as NLR and PLR and with lower L levels; insular location with lower L and higher NLR and PLR; the involvement of more than one lobe with higher N and NLR, midline shift with higher N, NLR and PLR and lower L. The correlation with inflammatory markers was confirmed for tumor volume in FLAIR, associated with higher N, NLR and PLR and lower L, contrast-enhanced volume, associated with higher PLR, and necrosis volume, associated with higher N, NLR and PLR and PLT. Significant predictors in univariate Cox regression analysis were midline and insular location, involvement of more than 1 lobe and multifocality. In the multivariate analysis multifocality had the greater impact on survival (HR 2, p = 0.037) while contrast-enhanced volume and necrosis volume had a significant but lower impact on survival (HR 1.04 and 0.94, respectively); a LMR > 3 was associated with a benefit in survival (HR 0.56, p = 0.041), while increasing platelets were associated with poor outcome, even if with a lower impact (HR 1.01, p < 0.001). Conclusion: We identified potential markers of systemic inflammation in gliobastoma patients calculated as ratios of preoperative blood cells counts (NLR, LMR, PLR) and proposed cut-points with significant impact on overall survival. We established a relationship between counts and ratios and radiological features, particularly tumor location, mass effect and volumes. We also identified a “trend” in blood cells counts and inflammatory markers correlated with those radiological features with a significant impact on survival. We identified platelets and lymphocytes (in the ratio relative to monocytes) as the inflammatory markers with the most significant effect on survival.