Objective: To explore the prognostic significance of inflammatory indicator, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), for advanced-stage diffuse large B-cell lymphoma (DLBCL). Methods: The data of advanced stage DLBCL cases was retrospectively collected, and all the patients were seen from January 2006 to December 2012 in National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences. The patients were divided into the low NLR group (≤5∶1) and the high NLR group (>5∶1); the low PLR group (≤300∶1) and the high PLR group (>300∶1). Kaplan-Meier method was used to compare the survival rates between groups, multivriate Cox proportional hazard regression analysis was performed to assess the independent prognostic significance of clinical and histopathological variables on events or OS. Results: A total of 361 patients were included in the study. Under a median follow-up of 89 months, the 5-year overall survival (OS) and progression-free survival (PFS) of the whole group were 42.9% and 31.3%, respectively. The 5-year OS rate and PFS rate were 48.2% and 35.1% in the low NLR group, which were 24.1% and 17.7% in the high NLR group, respectively. The 5-year OS rates and PFS rate were 45.4% and 33.2% in the low PLR group, which were 29.8% and 21.1% in the high PLR group (all P<0.05). Univariate analysis showed that NLR >5∶1, PLR >300∶1, age>60 year, ECOG PS>1 score, stage Ⅳ, B symptom, bulky disease, number of extranodal sites >1, Ki-67index >90%, LDH elevated and β2-MG elevated had significant influence on prognosis(all P<0.05). Multivariate analysis demonstrated that NLR, stage, B symptom, bulky disease, ECOG PS score, Ki-67 index and β2-MG were associated with poor prognosis in the advanced-stage DLBCL. Conclusions: NLR was simple and feasible biomarker for prognosis of advanced-stage DLBCL patients.
目的： 探索炎性指标，即中性粒细胞与淋巴细胞比值(NLR)及血小板与淋巴细胞比值(PLR)，在晚期弥漫大B细胞淋巴瘤(DLBCL)预后中的意义。 方法： 回顾性收集自2006年1月至2012年12月中国医学科学院肿瘤医院收治的初治、晚期DLBCL患者的相关临床资料，分析其人口学特点、分期及预后等特征。按照NLR的cut－off值为5，PLR的cut－off值为300，将全组患者分为低NLR组(≤5∶1)和高NLR组(>5∶1)及低PLR组(≤300∶1)和高PLR组(>300∶1)。采用Kaplan－Meier方案比较不同NLR组和PLR组5年总生存(OS)率和无进展生存(PFS)率，Logistic回归分析影响其预后的因素。 结果： 共计纳入研究患者361例，中位随访89个月。全组患者5年OS率为42.9%，5年PFS率为31.3%。低NLR组5年OS及低PLR组的5年OS率和5年PFS率均明显优于高NLR组及高PLR组，且差异有统计学意义(低NLR组5年OS率比高NLR组5年OS率为48.2%比24.1%，P<0.001；低PLR组5年OS率比高PLR组5年OS率为45.4%比29.8%，P＝0.003；低NLR组5年PFS率比高NLR组5年PFS率为35.1%比17.7%，P<0.001；低PLR组5年PFS率比高PLR组5年PFS率为33.2%比21.1%，P＝0.006)。单因素分析显示NLR>5∶1、PLR>300∶1、年龄>60岁、ECOG PS评分>1分、Ann Arbor分期为Ⅳ期、B症状、大肿块、结外受侵部位>1个、Ki－67指数>90%、LDH升高及β2－MG升高对预后有影响(P<0.05)。多因素分析显示NLR>5∶1、Ann Arbor分期为Ⅳ期、B症状、大肿块、ECOG PS评分>1分、Ki－67指数>90%及β2－MG升高为晚期DLBCL的独立预后影响因素(P<0.05)。 结论： 对于晚期DLBCL患者，NLR及PLR指标为简单可行的预后指标。与PLR相比，NLR的预测价值更高，是晚期DLBCL预后的一个重要指标。.
Keywords: Advanced-stage; Diffuse large B-cell lymphoma; Inflammatory indicators; Prognosis.