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      Serum albumin levels and serum albumin-globulin ratio are associated with poor prognosis in glioblastoma

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          Abstract

          Background

          Serum albumin levels (ALB) and albumin-globulin ratio (AGR) are reliable and convenient markers of the nutritional status and inflammation of human body, and ALB has been identified as a prognostic factor in the patients of glioblastoma (GBM). However, no literature has reported the prediction value of AGR for GBM.

          Methods

          In this study we evaluate the serum ALB and AGR levels for GBM. A total of 126 patients with GBM who underwent surgical resection in our institution between 2013 and 2017 were analyzed retrospectively. Clinical information was obtained from electronic medical records. Multiple logistic regression and Cox proportional hazards models were used to assess the prediction value of preoperative ALB and AGR for GBM.

          Results

          Preoperative ALB (HR 0.342, 95% CI, 0.123–0.954, P=0.040) and postoperative adjuvant therapy (HR 0.042, 95% CI, 0.005–0.330, P=0.003) were significantly related to progression-free survival (PFS). Cox regression analysis showed the significance of adjuvant therapy (HR 3.579, 95% CI, 2.236–5.729, P<0.001). Preoperative AGR (HR 0.280, 95% CI, 0.103–0.763, P=0.013) and adjuvant therapy (HR 0.156, 95% CI, 0.047–0.513, P=0.002) were showed significance, and Cox regression analysis showed preoperative AGR (HR 1.810, 95% CI, 1.095–2.992, P=0.021) and adjuvant therapy (HR 4.702, 95% CI, 2.841–7.782, P<0.001) were independent predictors of overall survival (OS).

          Conclusions

          The ALB and AGR had significant predictive values for the prognosis of GBM; postoperative adjuvant treatment is also an independent predictor for the prognosis of GBM patients.

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          Most cited references30

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          The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary.

          The 2016 World Health Organization Classification of Tumors of the Central Nervous System is both a conceptual and practical advance over its 2007 predecessor. For the first time, the WHO classification of CNS tumors uses molecular parameters in addition to histology to define many tumor entities, thus formulating a concept for how CNS tumor diagnoses should be structured in the molecular era. As such, the 2016 CNS WHO presents major restructuring of the diffuse gliomas, medulloblastomas and other embryonal tumors, and incorporates new entities that are defined by both histology and molecular features, including glioblastoma, IDH-wildtype and glioblastoma, IDH-mutant; diffuse midline glioma, H3 K27M-mutant; RELA fusion-positive ependymoma; medulloblastoma, WNT-activated and medulloblastoma, SHH-activated; and embryonal tumour with multilayered rosettes, C19MC-altered. The 2016 edition has added newly recognized neoplasms, and has deleted some entities, variants and patterns that no longer have diagnostic and/or biological relevance. Other notable changes include the addition of brain invasion as a criterion for atypical meningioma and the introduction of a soft tissue-type grading system for the now combined entity of solitary fibrous tumor / hemangiopericytoma-a departure from the manner by which other CNS tumors are graded. Overall, it is hoped that the 2016 CNS WHO will facilitate clinical, experimental and epidemiological studies that will lead to improvements in the lives of patients with brain tumors.
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            Cancer-related inflammation.

            The mediators and cellular effectors of inflammation are important constituents of the local environment of tumours. In some types of cancer, inflammatory conditions are present before a malignant change occurs. Conversely, in other types of cancer, an oncogenic change induces an inflammatory microenvironment that promotes the development of tumours. Regardless of its origin, 'smouldering' inflammation in the tumour microenvironment has many tumour-promoting effects. It aids in the proliferation and survival of malignant cells, promotes angiogenesis and metastasis, subverts adaptive immune responses, and alters responses to hormones and chemotherapeutic agents. The molecular pathways of this cancer-related inflammation are now being unravelled, resulting in the identification of new target molecules that could lead to improved diagnosis and treatment.
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              The epidemiology of glioma in adults: a "state of the science" review.

              Gliomas are the most common primary intracranial tumor, representing 81% of malignant brain tumors. Although relatively rare, they cause significant mortality and morbidity. Glioblastoma, the most common glioma histology (∼45% of all gliomas), has a 5-year relative survival of ∼5%. A small portion of these tumors are caused by Mendelian disorders, including neurofibromatosis, tuberous sclerosis, and Li-Fraumeni syndrome. Genomic analyses of glioma have also produced new evidence about risk and prognosis. Recently discovered biomarkers that indicate improved survival include O⁶-methylguanine-DNA methyltransferase methylation, isocitrate dehydrogenase mutation, and a glioma cytosine-phosphate-guanine island methylator phenotype. Genome-wide association studies have identified heritable risk alleles within 7 genes that are associated with increased risk of glioma. Many risk factors have been examined as potential contributors to glioma risk. Most significantly, these include an increase in risk by exposure to ionizing radiation and a decrease in risk by history of allergies or atopic disease(s). The potential influence of occupational exposures and cellular phones has also been examined, with inconclusive results. We provide a “state of the science” review of current research into causes and risk factors for gliomas in adults.
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                Author and article information

                Journal
                Transl Cancer Res
                Transl Cancer Res
                TCR
                Translational Cancer Research
                AME Publishing Company
                2218-676X
                2219-6803
                March 2020
                March 2020
                : 9
                : 3
                : 1594-1603
                Affiliations
                [1 ]deptDepartment of Neurosurgery , The First Affiliated Hospital of Xinjiang Medical University , Urumqi 830000, China;
                [2 ]deptDepartment of Intensive Care Unit , The First Affiliated Hospital of Xinjiang Medical University , Urumqi 830000, China;
                [3 ]deptDepartment of Imaging , The First Affiliated Hospital of Xinjiang Medical University , Urumqi 830000, China
                Author notes

                Contributions: (I) Conception and design: M Abudula, T Tuersun; (II) Administrative support: Q Fu; (III) Provision of study materials or patients: M Tiheiran; (IV) Collection and assembly of data: M Tiheiran, D Yisireyili; (V) Data analysis and interpretation: K Yalikun, Q Zhou; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

                Correspondence to: Qingjiu Zhou, MD. Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical University, Liyushan South Road 137, Urumqi 830000, China. Email: 1210253194@ 123456qq.com .
                Article
                tcr-09-03-1594
                10.21037/tcr.2020.01.57
                8798444
                35117507
                166a8b9a-72fd-429a-abcd-58ba0a373cce
                2020 Translational Cancer Research. All rights reserved.

                Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

                History
                : 29 October 2019
                : 03 January 2020
                Categories
                Original Article

                glioblastoma (gbm),albumin (alb),albumin-globulin ratio (agr),prognosis

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