A Novel Scoring System Based on Peripheral Blood Test in Predicting Grade and Prognosis of Patients with Glioma

Figures & data

Figure 1 ROC curves to assess the predictive value of preoperative fibrinogen, NLR and AGR. The cut-off values were 2.61 g/L for (A) fibrinogen, 1.90 for (B) NLR and 1.54 for (C) AGR; sensitivity, specificity and AUC: 80.4%, 67.9% and 0.770 for fibrinogen; 68.0%, 63.2% and 0.667 for NLR; 54.7%, 71.1% and 0.600 for AGR, respectively.

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; AGR, albumin-to-globulin ratio.

Table 1 Characteristics of Patients with Glioma

Variables	Value	%
Gender
Male	114	56.2%
Female	89	43.8%
Age (y)	44±14.61
<60	169	83.3%
≥60	34	16.7%
Tumor Location
Frontal	86	42.4%
Temporal	48	23.6%
Parietal	34	16.7%
Occipital	12	5.9%
Insular	12	5.9%
Others	11	5.4%
Tumor Size(cm)	5±1.42
<5	67	33.0%
≥5	136	67.0%
Extent of Resection
Total	153	75.4%
Not total	50	24.6%
WHO Grade
WHO I + II	93	45.8%
WHO III+IV	110	54.2%
Intracranial Infection
Yes	57	28.1%
No	146	71.9%
KPS
≥70	141	69.5%
<70	62	30.5%
Radiotherapy/Chemotherapy
Yes	109	53.7%
No	94	46.3%
Fibrinogen(g/L)	2.77±0.86	NA
NLR	2.28±1.72	NA
AGR	1.52±0.30	NA
WBC(×10^9/L)	6.48±2.15	NA
Neutrophil(×10^9/L)	3.94±1.84	NA
Lymphocyte(×10^9/L)	1.96±0.69	NA
F-NLR-AGR Score
0	39	19.2%
1	69	34.0%
2	67	33.0%
3	28	13.8%

Abbreviations: NLR, neutrophil to lymphocyte ratio; AGR, albumin to globulin ratio; KPS, Karnofsky performance status; F-NLR-AGR, combination of fibrinogen, albumin to globulin ratio and neutrophil to lymphocyte ratio.

Table 2 Association Between F-NLR-AGR and the Clinicopathological Characteristics of Patients with Glioma (n=203)

Variables	F-NLR-AGR Score 0 (n=39)	F-NLR-AGR Score 1 (n=69)	F-NLR-AGR Score 2 (n=67)	F-NLR-AGR Score 3 (n=28)	P-value
Gender
Male	22(56.4%)	37(53.6%)	36(53.7%)	19(67.9%)	0.594
Female	17(43.6%)	32(43.4%)	31(46.3%)	9(32.1%)
Age (y)
<60	36(92.3%)	58(84.1%)	53(79.1%)	22(78.6%)	0.297
≥60	3(7.7%)	11(15.9%)	14(20.9%)	6(21.4%)
Tumor Location
Frontal	16(41.0%)	35(50.7%)	27(40.3%)	8(28.6%)	0.123
Temporal	6(15.4%)	15(21.7%)	16(23.9%)	11(39.3%)
Parietal	5(12.8%)	9(13.1%)	15(22.4%)	5(17.8%)
Occipital	2(5.1%)	4(5.8%)	3(4.4%)	3(10.7%)
Insular	6(15.4%)	4(5.8%)	2(3.0%)	0(0.0%)
Others	4(10.3%)	2(2.9%)	4(6.0%)	1(3.6%)
Tumor Size(cm)
<5	10(25.6%)	26(37.7%)	24(35.8%)	7(25.0%)	0.578
≥5	29(74.4%)	43(62.3%)	43(64.2%)	21(75.0%)
Extent of Resection
Total	30(76.9%)	56(81.2%)	48(71.6%)	19(67.9%)	0.449
Not total	9(23.1%)	13(18.8%)	19(28.4%)	9(32.1%)
WHO Grade
WHO I + II	26(66.7%)	34(49.3%)	29(43.3%)	4(14.3%)	<0.001
WHO III+IV	13(33.3%)	35(50.7%)	38(56.7%)	24(85.7%)
Intracranial Infection
Yes	16(41.0%)	12(17.4%)	17(25.4%)	12(42.9%)	0.015
No	23(59.0%)	57(82.6%)	50(74.6%)	16(57.1%)
KPS
≥70	29(74.4%)	53(76.8%)	43(64.2%)	16(57.1%)	0.166
<70	10(25.6%)	16(23.2%)	24(35.8%)	12(42.9%)
Radiotherapy/Chemotherapy
Yes	26(66.7%)	36(52.2%)	35(52.2%)	12(42.9%)	0.195
No	13(33.3%)	33(47.8%)	32(47.8%)	16(57.1%)

Abbreviations: KPS, Karnofsky performance status; F-NLR-AGR, combination of fibrinogen, albumin to globulin ratio and neutrophil to lymphocyte ratio.

Figure 2 Correlations between fibrinogen, NLR and AGR in glioma patients.

Notes: The figure is shown as a scatter plot. The fibrinogen was positively correlated with (A) NLR and negatively correlated with (B) AGR.

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; AGR, albumin-to-globulin ratio.

Figure 3 Correlations between fibrinogen, NLR, AGR, F-NLR-AGR and glioma grade.

Notes: The figure is shown as a scatter plot. (A) The diversity of fibrinogen in different glioma grades. (B) The diversity of NLR in different glioma grades. (C) The diversity of AGR in different glioma grades. (D) Distribution of F-NLR-AGR score in high-grade and low-grade glioma patients.

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; AGR, albumin-to-globulin ratio; F-NLR-AGR, combination of fibrinogen, albumin to globulin ratio and neutrophil to lymphocyte ratio.

Figure 4 Kaplan-Meier survival curves for OS according to preoperative (A) fibrinogen, (B) NLR, (C) AGR, (D) F-NLR-AGR in patients with glioma.

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; AGR, albumin-to-globulin ratio; OS, overall survival; F-NLR-AGR, combination of fibrinogen, albumin to globulin ratio and neutrophil to lymphocyte ratio.

Table 3 The Univariate and Multivariate Cox Analyses of OS

Variables	Univariate Analysis		Multivariate Analysis
	HR (95% CI)	P-value	HR (95% CI)	P-value
Gender(Male/Female)	0.822(0.548–1.232)	0.342	0.998(0.630–1.583)	0.994
Age(<60/≥60 year)	2.308(1.441–3.698)	0.001	2.071(1.195–3.588)	0.009
Tumor location	0.966(0.844–1.106)	0.619	0.967(0.792–1.181)	0.743
Tumor size(<5/≥5 cm)	1.693(1.060–2.704)	0.027	1.339(0.797–2.249)	0.270
Extent of resection(Total/Not total)	1.729(1.136–2.633)	0.011	1.566(0.940–2.610)	0.085
WHO grade(WHOI+II/WHO III+IV)	5.863(3.567–9.636)	<0.001	5.301(2.912–9.650)	<0.001
Intracranial Infection(Yes/No)	0.952(0.594–1.524)	0.837	0.935(0.537–1.629)	0.813
KPS(≥70/<70)	1.604(1.066–2.413)	0.023	1.059(0.647–1.733)	0.820
Radiotherapy/Chemotherapy (Yes/No)	1.197(0.803–1.782)	0.377	1.374(0.846–2.231)	0.199
F-NLR-AGR		<0.001		<0.001
Score 0	1(reference)		1(reference)
Score 1	2.119(0.958–4.685)	0.064	1.136(0.468–2.759)	0.779
Score 2	5.110(2.383–10.957)	<0.001	3.622(1.554–8.445)	0.003
Score 3	8.144(3.600–18.422)	<0.001	3.738(1.497–9.332)	0.005

Abbreviations: KPS, Karnofsky performance status; F-NLR-AGR, combination of fibrinogen, albumin to globulin ratio and neutrophil to lymphocyte ratio.