Neutrophil–lymphocyte ratio dynamics are useful for distinguishing between recurrence and pseudoprogression in high-grade gliomas

Figures & data

Table 1 Association between clinicopathological variables of patients and PsPD and ePD

Factors	All cases No (%)	MRI enlarged		p-value
PsPD	ePD
Age years				0.781
≥50	88	27	17
<50	47	20	11
Gender				0.347
Female	65 (48.1)	25	18
Male	70 (51.9)	22	10
WHO performance status				0.090
0	12 (8.9)	8	3
1	108 (80)	35	17
2	15 (11.1)	4	8
Extent of surgical resection				0.301
Subtotal resection	76 (56.3)	28	20
Total resection	59 (43.7)	19	8
MGMT promoter status				<0.001
Methylated	50 (37)	38	5
Unmethylated	85 (63)	9	23
IDH1 status				0.535
Wild	70 (51.9)	19	15
Mutant	28 (20.7)	10	5
Unkown	37 (27.4)	18	8
Baseline NLR				0.197
≥4	65 (48.1)	29	13
<4	70 (51.9)	18	15
NLR decreased				0.022
Decreased	68 (50.4)	28	9
No decreased	67 (49.6)	19	19
NLR increased				0.128
Increased	47 (34.8)	13	13
No increased	88 (65.2)	32	15

Figure 1 MRI findings and outcomes of patients.

Abbreviations: MRI, magnetic; resonance imaging; HCGs, high-grade gliomas; TMZ, temozolomide; RT-TMZ, radiotherapy Concurrent TMZ chemotherapy; PD, disease progression; PsPD, pseudoprogression; ePD, early disease progression; MDT, multidisciplinary team.

Figure 2 Overall survival for pseudoprogression, early disease progression and neither pseudoprogression nor early disease progression.

Figure 3 Overall survival for different baseline NLRs.

Figure 4 Overall survival for increased and no increased NLR.

Abbreviation: NLR, neutrophil–lymphocyte ratio.

Figure 5 Overall survival for decreased and no decreased NLR.

Abbreviation: NLR, neutrophil–lymphocyte ratio.

Table 2 Univariate and multivariate logistic regression analyses for overall survival of high-grade glioma patients

Characteristic	Univariate			Multivariate
	Odds ratio	95% CI	p-value	Odds ratio	95% CI	p-value
Age	1.012	0.980–1.045	0.475
Gender	0.855	0.566–1.293	0.459
WHO performance status	1.312	0.808–2.130	0.272
Extent of surgery	0.508	0.331–0.778	0.002	0.604	0.380–0.962	0.034
MGMT promoter status	0.154	0.084–0.281	<0.001	0.160	0.085–0.302	<0.001
IDH1 status	0.629	0.466–0.849	0.002	0.885	0.646–1.212	0.47
Baseline NLR	1.150	1.028–1.286	0.014	1.029	0.928–1.141	0.584
NLR decreased	0.474	0.306–0.733	0.001	0.481	0.247–0.934	0.031
NLR increased	1.584	1.064–2.357	0.023	0.678	0.366–1.254	0.215

Note: Univariate variables with P<0.2 were included in the multivariate model.

Abbreviations: IDH1, isocitrate dehydrogenase 1; MGMT，O6-methylguanine–DNA methyltransferase; NLR, neutrophil-to-lymphocyte ratio.