Sibel Oyucu ORHAN, Bedrettin ORHAN, Ulviyya HASANZADE, Seda SALI, Burcu CANER, Birol OCAK, Ahmet Bilgehan ŞAHİN, Adem DELİGÖNÜL, Erdem ÇUBUKÇU, Türkkan EVRENSEL
Eurasian Journal of Medical Investigation - 2026;10(1):37-45
Objectives: Recurrent high-grade gliomas (rHGG) pose a significant challenge with poor prognosis. While bevacizumab plus irinotecan (BEV+IRI) is a frequent salvage regimen, clinical outcomes exhibit substantial inter-patient heterogeneity. Therefore, accessible prognostic biomarkers are needed to identify patients most likely to benefit. Methods: This retrospective, single-center study enrolled adults with recurrent WHO grade 3-4 gliomas treated with BEV+IRI. Pre-treatment laboratory data were used to calculate Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Systemic Immune-Inflammation Index (SII), Pan-Immune-Inflammation Value (PIV), and hemoglobin, albumin, lymphocyte, platelet (HALP) scores. Optimal cut-offs were determined via receiver operating characteristics (ROC) analysis. Survival was analyzed using Kaplan-Meier and Cox regression models. Results: In 43 patients, median overall survival (OS) was 9.6 months; median progression free survival (PFS) was 5.8 months. Patients with high pre-treatment NLR (>=6.74) had significantly shorter OS (4.4 vs. 11.4 months; p<0.001). Multivariate analysis confirmed high NLR as a strong independent risk factor for mortality (HR: 9.31, 95% CI: 3.18-27.28; p<0.001). Conversely, PIV, SII, PLR, and HALP scores showed no prognostic significance. While generally tolerable, the regimen caused vascular events in 14%. Conclusion: Among various inflammation indices, pre-treatment NLR emerged as a consistent and clinically relevant prognostic biomarker in rHGG patients treated with BEV+IRI. NLR-based stratification could optimize patient selection and reduce unnecessary toxicity.
