中性粒细胞/淋巴细胞比值对早期原发乳腺弥漫大B细胞淋巴瘤的临床特征及预后的影响

Effect of Neutrophil to Lymphocyte Ratio on Clinical Features and Prognosis of Patients with Early Primary Breast Diffuse Large B-cell Lymphoma

目的:探讨中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio, NLR)对早期原发乳腺弥漫大B细胞淋巴瘤(primary breast diffuse large B-cell lymphoma,PB-DLBCL)的临床特征、预后的影响。方法:回顾性分析2005年9月至2015年9月期间四川省肿瘤医院收治的45例早期PB-DLBCL患者临床资料。统计患者初诊时全血细胞计数中的中性粒细胞数、淋巴细胞数,计算治疗前NLR值。应用Kaplan-Meier法进行生存分析,单因素分析采用Log-rank检验,多因素分析采用Cox回归模型。结果:45例PB-DLBCL患者中,多为女性(97.8%),中位发病年龄45岁(28岁~77岁)。所有患者均以单侧无痛性乳腺包块为首发症状,其中右侧乳腺包块29例,左侧乳腺包块16例;伴有B组症状5例。所有患者均接受化疗,联合利妥昔单抗免疫治疗31例,接受局部放疗12例,接受预防性鞘内化疗14例。病理亚型(按Hans分型法则)示生化中心B细胞型(GCB)10例,非生化中心B细胞型(non-GCB)35例。中位随访时间97个月,中位无进展生存期未达到,中位总生存期38个月(12~78个月),3年总生存率(OS)68.9%。通过ROC曲线得到NLR的截断值(cut off值)3.211,分为低NLR组(≤3.211)、高NLR组(>3.211)。NLR与PB-DLBCL的Hans分型(P=0.020)、病变部位(P=0.015)及IPI评分(P=0.002)明显相关。单因生存分析显示,non-GCB(P=0.011)、Ⅱ期(P=0.038)、ECOG评分≥2分(P=0.002)、IPI评分≥2分(P=0.002)、NLR值>3.211(P=0.007)以及未行预防性鞘内化疗(P=0.002)是影响PB-DLBCL患者预后的因素;多因素分析中显示,ECOG评分、IPI评分、NLR及预防性鞘内化疗是影响OS的独立预后因素(P<0.05)。结论:NLR与PB-DLBCL的临床特征有相关性,是影响PB-DLBCL患者生存预后的独立危险因素。

Objective: To analyze the effect of neutrophil to lymphocyte ratio(NLR) on clinical features and prognosis of patients with early Primary Breast Diffuse Large B-cell Lymphoma(PB-DLBCL). Methods: Clinical data of 45 cases of early PB-DLBCL in Sichuan Cancer Hospital from September 2005 to September 2015 were retrospectively analyzed. The absolute neutrophils and lymphocytes in the complete blood cell count of the patients before treatment were counted, and the NLR was calculated. The Kaplan-Meier method was used for survival analysis. Univariate analysis was performed with Log-rank test and multivariate analysis was performed with the Cox-regression model. Results: Of the 45 patients with PB-DLBCL, most patients were females(97.8%). The median age was 45 years(28~77 years). The male to female ratio was 1:44. All patients had painless breast mass as the first symptom, it occurred in the right breast in 29 cases and in the left breast in 16 cases. B symptoms occurred in 5 cases. All patients received chemotherapy, 31 patients received Rituximab immunochemotherapy, 12 patients received local radiation therapy, and 14 patients received prophylactic intrathecal chemotherapy. As for the pathological subtype(Hans classification criteria), 10 patients were diagnosed with germinal center B-cell type(GCB type) and 35 patients were diagnosed with non-germinal center B-cell type(non-GCB type). The median follow-up time was 97 months. The median progression-free survival has not been reached. The median overall survival was 38 months(12~78 months) and 3-year overall survival rate for the 45 PB-DLBCL cases was 68.9%. The optimal cut off value of 3.211 for NLR was obtained by the ROC analysis and the patients were divided into two groups, low NLR group(≤3.211) and high NLR group(>3.211). NLR was significantly associated with Hans typing(P=0.02), site of lesion(P=0.015) and IPI score(P=0.002). The univariate analysis showed that non-GCB(P=0.011), stage Ⅱ(P=0.038), ECOG score ≥2(P=0.002), IPI score ≥2(P=0.002), NLR value>3.211(P =0.007) and no preventive intrathecal chemotherapy(P=0.002) were factors that affect the prognosis in patients with PB-DLBCL;multivariate analysis showed that ECOG score, IPI score, NLR and prophylactic intrathecal chemotherapy were independent risk factors(P < 0.05). Conclusion: NLR has a correlation with the clinical features of PB-DLBCL, and it may be an important independent prognostic factor of patients with PB-DLBCL.