ID #689 Diagnostic and Prognostic Value of Systemic Inflammatory Markers in Pediatric Brain Tumors: A Systematic Review
Salsabila Farradisya, Fatimah Saidah, Ludi Dhyani RahmartaniAbstract
Background
Pediatric brain tumors remain a major cause of childhood cancer-related morbidity and mortality. Systemic inflammatory markers from routine blood tests have shown diagnostic and prognostic relevance in adult cancers, but their role in pediatric brain tumors remains uncertain. Existing pediatric studies are limited and heterogeneous, warranting a systematic synthesis.
Methods
A systematic search of PubMed, Cochrane Library, ScienceDirect, and Epistemonikos identified 450 records. After duplicate removal and screening, eight retrospective single-center studies were included. Extracted markers included absolute neutrophil and lymphocyte counts, NLR, derived NLR (dNLR), platelet–lymphocyte ratio (PLR), lymphocyte–monocyte ratio (LMR), and the systemic inflammation response index (SIRI).
Results
Eight retrospective studies were included, comprising medulloblastoma (n = 3) and mixed pediatric CNS tumor populations (n = 5). Pediatric brain tumor patients showed higher absolute neutrophil counts and neutrophil–lymphocyte ratio (NLR) than controls, with neutrophil counts increasing by tumor grade (4.29 ± 0.77 × 109/L in grade I vs 6.59 ± 1.17 × 109/L in grade IV; AUC 0.709). NLR demonstrated the most consistent diagnostic performance, with higher values in medulloblastoma compared with controls (2.8 vs 1.8; p < 0.001; AUC up to 0.78). dNLR showed similar discrimination, and combined NLR–dNLR models improved accuracy (AUC 0.856–0.86), whereas PLR and LMR showed inconsistent diagnostic value. Prognostically, elevated NLR independently predicted worse overall and progression-free survival (aHR 1.9–2.14 and 1.78, respectively). Low LMR was strongly associated with inferior survival (OS and PFS aHR 0.05), while PLR was not prognostic. Elevated SIRI (>1.249) was associated with worse overall survival (aHR 2.29).
Conclusion
Current evidence indicates that systemic inflammatory markers, especially the neutrophil–lymphocyte ratio, are consistently associated with disease severity and survival in pediatric brain tumors. These findings support their potential role as low-cost adjunct biomarkers, although prospective studies are needed to confirm clinical applicability.