Prognostic Role of Inflammatory Blood Cell Ratios in Glioblastoma Patients: Insights from a Single-institution Study

Background/aim: Glioblastoma multiforme (GBM) is the most common and aggressive primary malignant brain tumor, with a poor prognosis despite standardized multimodal treatment. Recent research has explored the prognostic value of systemic inflammatory markers, which could provide accessible and cost-effective indicators of patient outcomes. Patients and methods: This retrospective single-center study analyzed patients with GBM treated between 2014 and 2024. Eligible patients underwent radiotherapy with concurrent and adjuvant temozolomide. Hematological parameters, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI), were assessed for prognostic significance. Overall survival (OS) was analyzed using Kaplan-Meier curves and Cox regression models. Results: A total of 74 newly diagnosed patients with GBM were included, with a median follow-up of 18 months. ROC curve analysis identified significant cutoff values for NLR, MLR, SII, and SIRI, which were associated with OS. Patients with elevated inflammatory markers had significantly worse OS. Median OS was significantly shorter in patients with elevated NLR (14 months vs. 21 months, p=0.01), MLR (13 months vs. 16 months, p=0.006), SII (14 months vs. 20 months, p=0.04) and SIRI (13 months vs. 20 months, p=0.001). No statistically significant correlation was found between inflammatory markers and MGMT promoter methylation status. Conclusion: This study confirms the prognostic relevance of systemic inflammatory markers, particularly NLR, MLR, SII, and SIRI, in patients with GBM. These easily obtainable parameters could complement molecular profiling in risk stratification and treatment planning, pending validation in prospective studies, and contribute to more personalized patient management.