The role of preoperative thrombocytic factors on survival in patients with glioblastoma: a meta-analysis and synopsis of the literature

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported but CIs exclude null for PLR

• Effect Size: PLR: HR 1.46; Platelet count: HR 1.38

• Primary Outcome: Overall survival in glioblastoma patients

• Nnt Or Sensitivity: 46% increased hazard of death with high PLR; 38% increased hazard with high platelet count

• Confidence Interval: PLR: 95% CI [1.23, 1.74]; PC: 95% CI [1.00, 1.90]

Clinical Application

Highly feasible - routine blood tests available in all Australian hospitals pre-operatively Readily applicable in Australian neurosurgical centres; platelet parameters are standard pathology tests covered by Medicare; could inform prognostic discussions and clinical trial stratification Adult patients with newly diagnosed glioblastoma undergoing surgical resection

Abstract

Glioblastoma (GBM) is the most common malignant primary brain tumour and is associated with poor prognosis. Platelet-related factors have been linked to outcomes in GBM, but evidence remains inconsistent. This review evaluates their prognostic value for survival. We conducted a systematic review and meta-analysis of studies on preoperative thrombocytic factors in GBM. PubMed, MEDLINE, and Embase were searched from inception to January 2025 using MeSH terms. Eligible studies included observational cohort studies of adults (≥ 16 years) with WHO grade 4 diffuse astrocytoma (GBM), ≥ 30 participants, and ≥ 3 months' follow-up after resection. Random-effects meta-analysis using restricted maximum likelihood with Hartung-Knapp adjustment was used to pool hazard ratios (HRs) of high vs. low parameters on overall survival (OS). Study quality was assessed with the Newcastle-Ottawa Scale. 21 studies were included. 13 (n = 2609) reported HRs of high vs. low platelet: lymphocyte ratio (PLR, median threshold = 150), with high PLR significantly associated with worse OS (pooled HR = 1.46, 95% CI [1.23, 1.74]). Eight studies (n = 1921) assessed platelet count (PC, median threshold = 208*109/L), showing high PC was a borderline predictor of worse OS (pooled HR = 1.38, 95% CI [1.00, 1.90]). Four studies (n = 1234) examined mean platelet volume (MPV, median cut-off = 9.05 fL), which qualitatively demonstrated worse OS in patients with high MPV or high MPV: PC ratio. One study assessed platelet distribution width (PDW, threshold = 14.7 fL), finding worse OS in the high PDW group. High preoperative PLR is associated with poor prognosis in GBM, while high PC demonstrates borderline increased risk, which may help refine risk stratification and guide future mechanistic studies.

References

1. 1.Akkara, Y., Hon, J. J., Rehman, S., de Groot, J., & Williams, M. (2026). The role of preoperative thrombocytic factors on survival in patients with glioblastoma: a meta-analysis and synopsis of the literature. Neurosurgical Review. https://doi.org/10.18632/oncotarget.21799