Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Oct 24, 2021; 12(10): 947-959
Published online Oct 24, 2021. doi: 10.5306/wjco.v12.i10.947
Novel molecular panel for evaluating systemic inflammation and survival in therapy naïve glioma patients
Puneet Gandhi, Richa Shrivastava, Nitin Garg, Sandeep K Sorte
Puneet Gandhi, Richa Shrivastava, Department of Research, Bhopal Memorial Hospital and Research Centre, Bhopal 462038, Madhya Pradesh, India
Nitin Garg, Sandeep K Sorte, Department of Neurosurgery, Bhopal Memorial Hospital and Research Centre, Bhopal 462038, Madhya Pradesh, India
Author contributions: Gandhi P conceived the concept, study design, interpretation of data, initial draft, and final review; Shrivastava R performed the data acquisition, analysis, and initial draft; Garg N and Sorte SK performed the patient enrollment, and clinical data and its interpretation.
Supported by Major Project Sanctioned by the Madhya Pradesh Council of Science & Technology to Dr. Puneet Gandhi, No. 249.
Institutional review board statement: The study was approved by institutional ethics and review committee (IRB/21/Res/11). The funding agency had no role in the study design of this project.
Informed consent statement: All study participants and/or legally authorized representative, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest, financial or any other.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Puneet Gandhi, MSc, PhD, Full Professor, Department of Research, Bhopal Memorial Hospital and Research Centre, Raisen Bypass, BMHRC Campus, Bhopal 462038, Madhya Pradesh, India. puneetgandhi67@yahoo.com
Received: April 30, 2021
Peer-review started: April 30, 2021
First decision: June 16, 2021
Revised: June 21, 2021
Accepted: August 20, 2021
Article in press: August 20, 2021
Published online: October 24, 2021
Processing time: 174 Days and 21.3 Hours
ARTICLE HIGHLIGHTS
Research background

Chronic persistent inflammation is a hallmark of glioma and a major contributor to the disease progression. Currently there are no serological or molecular markers that are routinely evaluated before deciding treatment and in the follow-up period for monitoring survival and therapeutic efficacy.

Research motivation

A non-invasive inflammatory marker panel is essential to define survival and plan for a better clinical outcome.

Research objectives

The objective of this investigation was to assess the utility of the non-invasive biomarker panel to estimate systemic inflammation and whether it can define and differentiate survival in glioma subgroups.

Research methods

Dot-immune assay for screening of the expression of molecular makers followed by estimation of circulatory levels by enzyme-linked immunosorbent assay are easy, cost-effective and sensitive methods even in resource limited settings. The expression of marker kynurenine (KYN) has been validated by immunofluorescence-immunohistochemistry in situ.

Research results

The molecular marker panel of KYN, interleukin-6, human telomerase reverse transcriptase and neutrophil-lymphocyte ratio were negatively correlated with mortality (P < 0.0001) and achieved higher sensitivity and specificity (> 90%) than stand-alone markers, to define survival. It could discriminate between WHO-grades, isocitrate-dehydrogenase-mutant/wildtype and define differential survival between astrocytic isocitrate-dehydrogenase-mutant/wildtype. Association of KYN with neutrophil-lymphocyte ratio, interleukin-6, and human telomerase reverse transcriptase was significant. Cox-regression described KYN, interleukin-6, neutrophil-lymphocyte ratio, and human telomerase reverse transcriptase, as good prognostic markers, independent of confounders. Multivariate linear-regression analysis confirmed a concomitant significant decrease in the levels of the markers, in a 3-mo follow-up.

Research conclusions

This is a first of its kind evidence-based study of a non-invasive panel that can estimate chronic systemic inflammation, wherein the identified over-expressed molecular markers can be targeted to design a personalized therapy.

Research perspectives

The study model when replicated in a bigger sized multicentric cohort can pave way for the use of the inflammatory molecular screen for routine patient care.