Perioperative leukocyte-plateletcrit shift as a prognostic signature in glioblastoma.

PURPOSE: Circulating inflammatory indices derived from routine blood counts may offer pragmatic prognostic information in glioblastoma (GB), yet the prognostic role of plateletcrit (PCT) and of peri-treatment dynamics in leukocyte-platelet coupling remains underexplored. METHODS: We retrospectively studied 95 adults with histologically confirmed GB (48 men, 47 women; median age 64.5 years) treated adjuvantly with radiotherapy and chemotherapy with complete blood counts obtained at four windows: pre-operative, post-operative, pre-adjuvant, and post-adjuvant. From leukocytes, platelets (PLT), plateletcrit (PCT), and mean platelet volume (MPV) we derived all within-timepoint ratios and inter-timepoint differences (Δ). Overall survival (OS) in days was modeled using Cox proportional hazards (per + 1 SD), with Benjamini-Hochberg false-discovery summaries; a multivariable model adjusted for age, sex, extent of resection, radiotherapy, concomitant temozolomide (TMZ), and number of adjuvant TMZ cycles was calculated. RESULTS: Median overall survival (OS) was 406 days, with 80 deaths. In univariate models, dynamic indices predominated: the post-operative rise in leukocytes relative to plateletcrit (Δ post-op - pre-op leu/PCT) showed the strongest adverse association (HR 1.60, 95% CI 1.22-2.10; p = 0.0007; BH-FDR q = 0.09), with concordant signals for Δ leu/PLT (HR 1.43, 95% CI 1.14-1.79; p = 0.002) and a protective inverse for Δ PCT/leu (HR 0.66, 95% CI 0.50-0.87; p = 0.003). Cross-sectionally, higher post-operative leu/PCT and leu/PLT and higher post-adjuvant leukocytes and leu/MPV were adverse (all p < 0.05). In the multivariable model adjusting for age, sex, extent of resection, radiotherapy, concomitant temozolomide (TMZ), and number of adjuvant TMZ cycles, Δ leu/PCT remained independently associated with worse OS (HR 1.62, 95% CI 1.04-2.52; p = 0.031), while concomitant TMZ (HR 0.18, 95% CI 0.05-0.68; p = 0.012) and greater adjuvant TMZ exposure (per + 1 SD; HR 0.48, 95% CI 0.29-0.78; p = 0.003) were protective. CONCLUSIONS: Dynamic leukocyte-platelet coupling-especially Δ (post-op - pre-op) leu/PCT-provides independent prognostic information beyond standard covariates. CBC-based trajectories are low-cost and scalable and warrant prospective validation. Interpretation is limited by the absence of systematic MGMT methylation data and requires external validation and comparison with other prognostic scoring systems.