外周血淋巴细胞和单核细胞比值对儿童霍奇金淋巴瘤预后的意义

The study of correlation between peripheral blood lymphocyte/monocyte ratio and prognosis in pediatric Hodgkin's lymphoma

目的成人霍奇金淋巴瘤（HL）研究显示外周血淋巴细胞绝对值与单核细胞绝对值的比值（absolute lymphocyte count/absolute monocyte count ratio,LMR）具有预后意义。而在儿童HL中鲜有研究,本研究主要探讨LMR在儿童HL中的预后价值。方法回顾性分析中山大学肿瘤防治中心从1998年1月-2013年10月收治的107例初诊年龄〈18岁儿童青少年HL的临床资料,收集和分析患者初诊时的外周血淋巴细胞绝对值（absolute lymphocyte count,ALC）、淋巴细胞百分比（1ymphocyte percentage,LYM%）和单核细胞绝对值（absolute monocyte count,AMC）等数据,通过SPSS中受试者工作特征曲线（receiver operating characteristic curve analysis,ROC）获得淋巴细胞绝对值与单核细胞绝对值比值LMR、LYM%、AMC与及ALC的最佳临界值,在该临界值上敏感度与精确度都达到最大值。再进行单因素和多因素分析其与预后的关系。结果 107例儿童HL纳入分析,男80例,女27例,中位年龄10（2～18）岁。Ⅰ期5例,Ⅱ期50例,Ⅲ期33例,Ⅳ期19例。所有患者采用ABVD为基础的化疗方案±放疗。107例患者LMR的最佳临界值是2.15（P=0.006）,LMR/≥2.15患者66例,LMR〈2.15患者41例。中位随访时间51.2（7～204）个月。全组5年EFS和OS分别为82.3%和96.7%。LMR≥2.15组和LMR〈2.15组患者5年EFS分别为87.9%和70.7%（P=0.041）。两组5年OS分别为97.0%和95.1%;P=0.815）。单因素分析LMR、LYM%和Ⅳ期是儿童HL的EFS预后因素;多因素分析LMR为非独立预后因素,仅Ⅳ期为独立预后因素。结论本研究显示儿童HL患者初诊外周血LMR是影响EFS的预后因素之一,值得进一步研究。

Objective Recent studies suggested that absolute lymphocyte count/absolute monocyte count ratio（LMR） at diagnosis may predict survival in adults with Hodgkin lymphoma（HL）.Equivalent data in pediatric HL are sparse.In this study we mainly aimed to determine the prognostic significance of LMR in pediatric HL.Methods The patients younger than 18 years old diagnosed as HL and treated in Sun Yat-Sen University Cancer Center from January 1998 to October 2013 were analyzed.Datas of absolute lymphocyte count（ALC）,Lymphocyte percentage（LYM%） and absolute monocyte count（AMC） in the patients＇ peripheral blood at diagnosis were collected and analyzed.Using receiver operating characteristic curve（ROC） analyze the optimal cut-off value of ALC,LYM%,AMC,LMR.The association of these candidate variables with over-all survival（OS） and event-free survival（EFS）were determined with Cox regression.Results The final study cohort comprised 107 HL patients.The median age was 10（2-18） years old with 80 male patients and 27 female patients.All patients received ABVD based chemotherapy and/or radiotherapy.The optimal cut-off value of LMR for all patients was2.15（P =0.006）.including 66 patients LMR≥2.15 and 41 patients LMR 〈2.15.The median follow-up time was 51.2 months（Range,7-204 months）.The estimated 5year event-free survival（EFS） rate was82.3%and 5-year overall survival（OS） rate was 96.7%for the total patients.Patients with LMR 〈2.15 had significantly lower 5y-EFS compared with those LMR 2.15,that is,87.9%vs 70.7%（P = 0.041）;5y-OS is 95.1%vs97.0%（P = 0.815）.In univariate analysis,LMR,LYM%and Stage IV were the prognostic factors for pediatric HL patients in EFS.In multivariate analysis,Stage IV remained a significant prognostic factor,however,LMR,LYM%were not independent prognostic marker.Conclusions Our study showed LMR of peripheral blood in newly diagnosis pediatric HL was one of the prognostic factors for EFS.