Pre-operative Mean Platelet Volume (MPV) is associated with Glioblastoma IDH-wt overall survival, preliminary data from 167 patients

Background. Glioblastoma (GBM) is the most common, fast-growing, and aggressive malignant primary CNS tumor, with a survival time of about 15 months despite surgery and adjuvant treatments. In recent years, there has been a growing interest in exploring the potential contribution of hemostasis and platelet activation in GBM biology. This study aims to address the association between pre-operative coagulation profile (PT ratio, aPTT ratio), overall platelets’ count (PC), and the mean platelet volume (MPV) with tumoral characteristics and overall survival in GBM IDH-wt patients. Methods. A total of 167 adult patients undergoing maximal safe resection of newly diagnosed glioblastoma WHO grade 4 IDH-wt were included. The variables of interest (MPV, PT ratio, and aPTT ratio) were dichotomized at the median, while the overall PC was split up using the central distribution (10th to 90th percentile). Correlation analyses of markers with tumoral and demographic characteristics, Kaplan Meier survival analysis, and Cox multivariate regression analysis were conducted to explore the single contributions of these parameters in building a predictive model of overall survival (OS) in these patients. Results. The mean baseline MPV correlated to increasing age (r=0.18, p=0.01), the overall FLAIR tumoral volume (r=0.17, p=0.02), and lesional contrast-enhanced (T1-CE) volume (r=0.19, p=0.01). The median OS in the whole cohort of GBM patients was 14.4 months (95% CI: 12.9-17.6). Patients with MPV > 10.3 10-15L had a median OS of 13.4 months (95% CI: 10.6-17.6) compared to 14.5 months (95% CI: 13.4-20.6) in patients with MPV <= 10.3 10-15L, p = 0.028. Similarly, shorter OS was recorded in patients with PT ratio > 1.01 (p=0.006), and PC out-of-range 165-300 109/L (p=0.026). A subgroup analysis of patients > 65 years confirmed baseline MPV > 10.3 10-15L was associated with shorter OS (9.4 months, 95% CI: 8.1-13.4) compared to 13.3 months (95% CI: 11.3-32.3, p = 0.026). Baseline increased MPV showed an independent predictive role for poor survival (HR: 1.29, 95% CI 1.01-1.66, p=0.04) in multivariate analysis accounting for age, gender, pre-operative performance status, and tumoral molecular and radiological characteristics, whereas PC within central range had a protective role (HR: 0.47, 95% CI 0.26-0.88, p=0.01). Conclusions. This study highlights an intriguing association between tumoral burden and systemic hemostasis activation in GBM IDH-wt patients. Increased MPV and deranged PC outside the central range were independent in predicting shorter OS, which was even more prominent among older patients. These preliminary data require additional studies to further characterize glioblastoma pathological features of aggressiveness related to neo-angiogenesis, tumor immune microenvironment, hemostasis activation, and their effect on response to treatments and OS.