De Ritis ratio in elderly glioblastoma patients treated with chemoradiation: a comprehensive analysis of serum biomarkers

We aimed to comprehensively investigate the prognostic value of pre-treatment laboratory parameters in elderly patients with glioblastoma treated with temozolomide (TMZ)-based chemoradiation. Patients aged ≥65 years from four institutions with newly diagnosed IDH-wild-type glioblastoma who received radiotherapy (RT) with concurrent TMZ between 2006 and 2021 were included. Patient factors (age, Karnofsky performance status (KPS), temporalis muscle thickness (TMT)), molecular factors (MGMT promoter methylation, EGFR amplification, TERT promoter mutation, and TP53 mutation status), treatment factors (extent of resection, and RT dose), and pre-treatment laboratory parameters (serum De Ritis ratio, glucose level, neutrophil-to-lymphocyte ratio, platelet count, and systemic immune-inflammation index) were included in the analysis. The primary endpoint was overall survival (OS). In total, 490 patients were included in the analysis. The median follow-up period was 12.3 months (range, 1.6–149.9 months). Median OS was significantly prolonged in patients with De Ritis ratio <1.2 (18.2 months vs. 15.3 months, p = 0.022) and in patients with glucose level <150 mg/dL (18.7 months vs. 16.5 months, p = 0.034) per univariate analysis. In multivariate analysis, KPS ≥70, MGMT promoter methylation, extent of resection greater than partial resection, De Ritis ratio <1.2, and glucose level <150mg/dL were significant prognostic factors for improved OS. Along with well-known prognostic factors, pre-RT serum biomarkers, including the De Ritis ratio and glucose level, also had prognostic value in elderly patients with glioblastoma treated with TMZ-based chemoradiation.