动态监测外周血淋巴细胞与单核细胞比值对弥漫大B细胞淋巴瘤患者的疗效判断和预后指导意义

Efficacy and prognosis of the dynamic monitoring lymphocyte to monocyte ratio in patients with diffuse large B-cell lymphoma

目的探讨动态监测淋巴细胞与单核细胞比值(LMR)对弥漫大B细胞淋巴瘤(DLBCL)患者的疗效判断和预后指导意义。方法回顾性分析2012年03月至2018年03月郑州大学附属肿瘤医院261例DLBCL患者的临床资料。通过受试者工作特征曲线(ROC)确定LMR的最佳临界值,将患者分为低LMR组和高LMR组。动态监测两组患者治疗前和治疗后不同时间点的LMR变化,并分析其与疗效和生存的关系。结果发病初高LMR组患者的完全缓解(CR)率(64.7%)明显高于低LMR组(33.3%)(P<0.05)。与发病初低LMR组患者的5年总生存率和无进展生存率(分别为56.96%和43.55%)相比,高LMR组患者均较高(分别为82.92%和66.25%;均P<0.05)。高(或)低LMR组治疗后LMR增高患者的5年总生存率和无进展生存率均高于治疗后LMR降低患者(均P<0.05)。高/低LMR两组患者复发时LMR均较末次随诊时明显降低(均P<0.05)。单因素及多因素分析均显示,低LMR是DLBCL患者的独立预后不良因素(均P<0.05)。结论LMR可作为DLBCL患者危险度分层、疗效评估、疾病复发和预后判断的指标。发病初、治疗结束时,低LMR均为DLBCL患者的预后不良因素。

Objective To investigate the efficacy and prognosis of the dynamic monitoring lymphocyte to monocyte ratio(LMR)in patients with diffuse large B-cell lymphoma(DLBCL).Methods The clinical data of 261 patients with DLBCL in the Affiliated Cancer Hospital of Zhengzhou University between March 2012 to March 2018,were analyzed retrospectively.The optimal cut-off values of LMR was determined using the receiver operating characteristic curve(ROC)method.Patients were divided into low LMR group and high LMR group according to the optimal cut-off value.The changes of LMR before and after treatment in two groups were dynamically monitored,and the relationship between LMR and efficacy and survival were analyzed.Results Complete remission(CR)rate in patients with high LMR(64.7%)before treatment was significantly higher than that in patients with low LMR(33.3%)(P<0.05).Compared with the 5-year overall survival(OS)and progress free survival(PFS)(56.96% and 43.55%,respectively)in the low LMR group,the 5-year OS and PFS(82.92% and 66.25%,respectively)in the high LMR group were higher,and the difference was statistically significant(all P<0.05).Patients with elevated LMR after treatment in the high or low LMR group had a significant higher 5-year OS and PFS compared with patients with LMR reduction(P<0.05).LMR in both high and low LMR group were significantly lower at the last follow-up than those at the disease recurrence(all P<0.05).Both single and multivariate analyses showed that low LMR was an independent prognostic factor in patients with DLBCL(all P<0.05).Conclusions LMR can be used as an indicator of risk stratification,efficacy,disease replase and prognosis in patients with DLBCL.Low LMR before and after treatment were poor prognostic factors in patients with DLBCL.