Journal of Neuro-Oncology

, Volume 137, Issue 2, pp 279–287 | Cite as

Sex-dependent association of preoperative hematologic markers with glioma grade and progression

  • Wenshen Xu
  • Dengliang Wang
  • Xiaobin Zheng
  • Qishui Ou
  • Liming Huang
Clinical Study


Neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte ratio, the systemic immune-inflammation index (SII), and red blood cell distribution width (RDW), have been recognized as promising predictors for histological grade and prognosis in multiple cancer types. However, few investigations illustrated the impacts of sex on the clinical utility of hematologic markers. Patients with primary gliomas were retrospectively reviewed. The association between grade and inflammatory markers by sex were investigated by univariate and multivariate analysis. The discrimination ability of logistic regression model was evaluated by the area under the receiver-operating characteristic curve (AUC) for high-grade glioma (HGG). Kaplan–Meier progressionfree survival (PFS) curves were plotted to assess the prognostic value of RDW. In subgroup analysis, distinctively elevated NLR and SII levels were exclusively present in male HGGs group (p = 0.001); whereas RDW notably increased in female HGGs group (p = 0.001). On multivariate analysis, increased odds ratio of HGGs was exclusively observed for female patients with elevated RDW (odds ratio = 1.589). Moreover, regression model developed by RDW exhibited an excellent discriminative ability for the prediction of HGGs in female patients (AUC = 0.817). Median progression time with RDW < 13.2 versus RDW ≥ 13.2 was 62.5 versus 33.0 months (log rank p = 0.017). Older females (≥ 45 years) with increased RDW levels portended worse survival (HR 3.693, 95% CI 1.747–8.325, p = 0.001). Meanwhile, the significant association of RDW levels with PFS in male subgroup was not observed (p > 0.05). In conclusion, superior to NLR and SII, RDW would be sex-specific predictor for tumor grade and progression for HGG female patients.


Glioma Sex Systemic immune-inflammation index Neutrophil-to-lymphocyte ratio Red blood cell distribution width 



Neutrophil-to-lymphocyte ratio


Glioblastoma multiform


Body mass index


Red blood cell distribution width


Mean corpuscular volume


White blood cell




Mean platelet volume




Hepatitis B virus surface antigen


Red blood cell


Systemic immune-inflammation index


High-sensitivity C-reactive protein


Erythrocyte sedimentation rate


High-grade glioma


Low-grade glioma


Odds ratio


The area under the receiver-operating characteristic curve


Hazard ratio



This work was sponsored by Medical Elite Cultivation Program of Fujian Provincial Commission of Health and Family Planning, P.R.C (No. 2016ZQN44) and Startup Fund for Scientific Research, Fujian Medical University (No. 2016Y91010119), and Educational and Scientific Research Program of Fujian Provincial Department of Education (No. JAT170240).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethics Committee of the First Affiliated Hospital of Fujian Medical University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this retrospective study formal consent is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of Laboratory Medicine, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
  2. 2.Department of Neurosurgery, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
  3. 3.The First Department of Chemotherapy, The First Affiliated HospitalFujian Medical UniversityFuzhouChina

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