外周血淋巴细胞/单核细胞比值及2个疗程后PET评价在成人霍奇金淋巴瘤中的预后意义

The prognostic significance of peripheral lymphocyte/monocyte ratio and PET-2 evaluation in adult Hodgkin's lymphoma

目的探讨淋巴细胞/单核细胞比值(LMR)及2个疗程后PET评价(PET-2)在成人霍奇金淋巴瘤(HL)中的预后价值.方法回顾性分析2007年1月至2016年3月南京医科大学第一附属医院133例初诊成人HL患者的临床资料.采用X-tile软件确定变量的最佳临界值,生存分析采用Kaplan-Meier法及Cox回归.结果133例HL患者中位年龄33(18~84)岁,男女比例1.9∶1.LMR最佳临界值为2.5,LMR<2.5组无进展生存(PFS)时间(P<0.001)和总生存(OS)时间(P<0.001)均较LMR≥2.5组显著缩短.多因素生存分析显示LMR<2.5是HL患者PFS(HR=2.35,95%CI 1.36~4.07,P=0.002)和OS(HR=10.36,95%CI 2.35~45.66,P=0.002)的独立预后因素.56例患者的PET-2结果分析显示,PET-2阳性患者PFS明显差于PET-2阴性患者(P=0.022).根据LMR和PET-2将患者分为PET-2阴性且LMR≥2.5、PET-2阳性或LMR<2.5、PET-2阳性且LMR<2.5三组,三组间的PFS和OS差异均有统计学意义(P值分别为0.009和0.012).结论LMR<2.5是成人HL患者的独立预后不良因素.PET-2与LMR结合的预后价值可能更好.

Objective To evaluate the prognostic value of lymphocyte to monocyte ratio(LMR)and PET scan performed after first two cycles of chemotherapy(PET-2)in Hodgkin's lymphoma(HL).Methods The clinical data of 133 patients with HL diagnosed from January 2007 to March 2016 at the First Affiliated Hospital of Nanjing Medical University,were retrospectively analyzed.The X-tile software was used to calculate the optimal cut-off value of LMR.Kaplan-Meier method and Cox regression were used for survival analysis.Results The median age of 133 HL patients was 33(18-84)years,and the male to female ratio was 1.9:1.The optimal cut-off value of LMR was 2.5,and progression free survival(PFS)(P<0.001)and overall survival(OS)(P<0.001)were significantly lower in the LMR<2.5 group than that of LMR≥2.5.Multivariate survival analysis showed that LMR<2.5 was an independent predictor of PFS(P=0.002,HR=2.35,95%CI 1.36-4.07)and OS(P=0.002,HR=10.36,95%CI 2.35-45.66)in HL patients.The analysis of PET-2 from 56 HL patients showed that PET-2 positive patients had significantly poorer PFS(P=0.022).After grouping LMR combined with PET-2,significant differences were found in PFS and OS between the three groups(P values were 0.009 and 0.012).Conclusion LMR<2.5 is an independent prognostic factor for patients with HL.PET-2 combined with LMR may have better prognostic value.