MNGO-09. PROGNOSTIC SIGNIFICANCE OF PRE-OPERATIVE ANEMIA AND LEUKOCYTOSIS ON RECURRENCE-FREE SURVIVAL IN MENINGIOMA

Abstract

OBJECTIVES: Definite pretreatment predictors for tumor recurrence in meningioma are not well defined. Several studies in solid malignant tumors from various sites including glioblastoma have indicated the association of pre-treatment anemia and/or changes in number of leukocytes in peripheral blood with patient outcomes. We hypothesized those changes in complete blood count (CBC) before tumor resection can be used as one of the prognostic factors for tumor recurrence in meningioma. MATERIAL & METHODS: We gathered the clinical and pathological data from 226 histologically confirmed meningioma patients as well as results of CBC collected within 1 week before neurosurgical resection conducted at the Toronto Western Hospital between 2001 and 2015. Results were compared with recurrence-free survival (RFS) using univariable and multivariable analyses. RESULTS: Using standard cut-offs in our laboratory, anemia, leukocytosis and neutrophilia were identified in 56 (25%), 59 (26%) and 70 (31%) patients, respectively. These were distributed in patients among all 3 grades. The majority of patients had normocytic anemia (45/56). On univariate analysis, the presence of anemia (P=0.0003), leukocytosis (P=0.0123), and neutrophilia (P=0.0008) correlated with worse RFS. We found combined leukocytosis and anemia in 27/226(12%) patients who had a particularly poor outcome. On multivariable analysis after adjustment for malignancy grade and extent of resection, leukocytosis plus anemia remained independently prognostic for RFS (P<0.0001, HR=5.35). Lymphopenia and monocytosis were observed in 88(39%) and 32 (14%) of patients, respectively and both of them showed a trend toward poorer RFS. CONCLUSION: The presence of anemia, leukocytosis in the pre-operative CBC may suggest tumor recurrence in patients with meningioma and should be examined in additional cohorts. Further studies to explain the effect of pre-treatment anemia and changes in number of leukocytes, neutrophils and lymphocytes in peripheral blood on tumor progression and risk stratification of these patients are needed.