{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T04:46:42Z","timestamp":1791866802245,"version":"4.3.4"},"reference-count":32,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Systemic inflammation contributes to tumor growth and spread. We aimed to evaluate the association of pretreatment inflammatory indices and clinical and laboratory factors with survival in newly diagnosed grade 4 diffuse glioma. Methods: A total of 120 patients diagnosed with grade 4 diffuse glioma at four centers between 2013 and 2026 were analyzed retrospectively. Nine indices derived from complete blood counts were calculated. Overall survival (OS) and progression-free survival (PFS) were analyzed with Kaplan\u2013Meier and multivariable Cox regression. The cut-off for the systemic inflammation response index (SIRI) was determined with maximally selected rank statistics. Ten machine learning models were compared with the Cox model using repeated cross-validation. Results: Median follow-up was 70 months. Median OS was 22.8 months (95% confidence interval [CI] 15.8\u201326.3) and median PFS was 10.9 months (95% CI 9.1\u201314.4). In the multivariable model, SIRI &gt; 2.85 was independently associated with OS (hazard ratio [HR] 2.62, 95% CI 1.38\u20134.96, p = 0.003), and this association persisted in the isocitrate dehydrogenase (IDH)-wildtype subgroup (HR 3.06, 95% CI 1.27\u20137.39, p = 0.013). Hemoglobin was independently associated with PFS (HR per g\/dL 0.84, 95% CI 0.73\u20130.96, p = 0.011). Smoking was an independent indicator of poor prognosis for both OS (HR 2.02) and PFS (HR 1.73). Ki-67 and tumor size were not associated with survival. Machine learning models did not outperform the Cox model, and their variable importance rankings were consistent with the classical analysis. Conclusions: Pretreatment SIRI, hemoglobin, and smoking were independently associated with survival in grade 4 diffuse glioma. These markers are available from routine tests and may contribute to prognostic assessment.<\/jats:p>","DOI":"10.3390\/cancers18193192","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T16:50:38Z","timestamp":1790959838000},"page":"3192","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Value of Systemic Inflammation Markers and Clinical Factors in Grade 4 Diffuse Glioma: A Multicenter Retrospective Real-World Study"],"prefix":"10.3390","volume":"18","author":[{"given":"Ece","family":"Ulukal Karanc\u0131","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Antalya City Hospital, Antalya 07080, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gamze","family":"Emin","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon 61080, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet","family":"Oru\u00e7","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya 42080, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esma","family":"U\u011fuztemur","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Ad\u0131yaman Training and Research Hospital, Ad\u0131yaman 02040, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atila","family":"Y\u0131ld\u0131r\u0131m","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon 61080, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melek","family":"Karakurt Ery\u0131lmaz","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya 42080, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"As\u0131m Arma\u011fan","family":"Ayd\u0131n","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Antalya Training and Research Hospital, Antalya 07100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"iv1","DOI":"10.1093\/neuonc\/noaf194","article-title":"CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2018\u20132022","volume":"27","author":"Price","year":"2025","journal-title":"Neuro-Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1056\/NEJMoa043330","article-title":"Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma","volume":"352","author":"Stupp","year":"2005","journal-title":"N. 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