Association between preoperative hematologic markers and aggressive behavior in meningiomas

• Published in: Clinical neurology and neurosurgery 2023-03, Vol.226, p.107629-107629, Article 107629
• Main Authors: Guidry, Bradley S., Chotai, Silky, Tang, Alan R., Le, Chi H., Grisham, Candace J., McDermott, Jake R., Kelly, Patrick D., Morone, Peter J., Thompson, Reid C., Chambless, Lola B.
• Format: Article
• Language: English
• Subjects: 2-Methylisoborneol; Age; Biomarkers; Brain cancer; Calcification; Dexamethasone; DNA methylation; Edema; Humans; Invasiveness; Leukocytes (neutrophilic); Lymphocytes; Lymphocytes - pathology; Malignancy; Medical prognosis; Meningeal Neoplasms - surgery; Meningioma; Meningioma - surgery; Monocytes; Monocytes - pathology; Neoplasm Recurrence, Local - surgery; Neurology; Neutrophils; Patients; Prognosis; Recurrence; Retrospective Studies; Staging; Statistical analysis; Statistical significance; Steroids; Surgery; Tumors
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2023.107629

Meningiomas have varying degrees of aggressive behavior. Some systemic hematologic makers are associated with malignancy, but their value in predicting aggressive meningioma behavior is not fully understood. To evaluate the association between preoperative markers such as neutrophil-lymphocyte ratio (NLR), neutrophil-monocyte ratio (NMR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), and prognostic nutritional index (PNI), and diagnostic and prognostic factors including WHO grade, proliferation index, presence of edema on preoperative MRI, and tumor recurrence. A retrospective review of patients treated between 2000 and 2019 with a preoperative complete blood count (CBC) differential lab draw before intracranial meningioma resection was conducted. All preoperative steroid dosages were converted to dexamethasone equivalents. Primary outcomes included presence/absence of perilesional edema, WHO grade, Ki-67/MIB-index, and recurrence. Univariate and multivariable regression analyses were conducted. A total of 209 meningioma patients were included. Of these, 143 (68 %) were WHO grade I, 61 (29 %) grade II and 5 (2 %) were grade III. Recurrence was reported in 19 (9.1 %) tumors. No hematologic markers were associated with recurrence. In separate multivariable logistic analyses, no biomarkers were associated with perilesional edema or WHO grade. MLR was associated with higher MIB-index (p = 0.018, OR 6.57, 95 % CI 1.37–30.91). Most hematologic markers were not associated with meningioma invasiveness, grade, proliferative index, or aggressiveness. Preoperative MLR was associated with high proliferation index in patients undergoing surgery for intracranial meningioma. Higher MLR could be a surrogate for meningioma proliferation and has potential to be used as an adjunct for risk-stratifying meningiomas. •Hematologic biomarkers are derived from the complete blood count differential.•Biomarkers have shown prognostic utility in many intracranial tumors.•Biomarkers in meningioma prognostication is not fully understood.•We examined a host of hematologic biomarkers in meningioma prognosis.•Preoperative monocyte-lymphocyte ratio predicted high proliferation index.