外周血NLR、LMR对睾丸原发性弥漫性大B细胞淋巴瘤患者预后的预测价值

The Prognostic Value of Blood Neutrophils-to-Lymphocyte Ratio and Lymphocyte-to-Monocyte Ratio for Patients with Primary Testicular Diffuse Large B-Cell Lymphoma

目的探讨外周血中性粒细胞与淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、淋巴细胞与单核细胞比值(lymphocyte/monocyte ratio,LMR)对睾丸原发性弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)患者预后的预测价值。方法收集2005年1月至2015年1月本院确诊的28例睾丸原发性DLBCL为研究对象,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析NLR、LMR预测睾丸原发性DLBCL患者的无进展生存率(progression-free survival,PFS)、总生存率(overall survival,OS)最佳截点,并根据此节点将患者分为高比值组和低比值组。采用Kaplan-Meier法、单因素及多因素Cox回归分析影响患者PFS、OS的独立危险因素。结果患者PFS、OS差异最具统计学意义的LMR cut-off值是3.39、3.31,NLR cut-off值是2.49、2.66,NLR≤2.49组患者PFS高于NLR>2.49组,LMR>3.39组患者PFS高于LMR≤3.39组,差异具有统计学意义(P=0.003、0.004),NLR≤2.66组患者OS高于NLR>2.66组,LMR>3.31组患者OS高于LMR≤3.31组,差异具有统计学意义(P=0.025、0.010)。Cox单因素分析显示,国际预后指数(IPI)评分(P=0.010)、血清LDH水平(P=0.017)、中性粒细胞数(P=0.018)、单核细胞绝对数(P=0.001)、NLR(P=0.003)、LMR(P=0.004)和全身免疫炎症指数(systemic immune-inflammation index,SII)(P=0.005)与睾丸原发性DLBCL患者PFS有关,多因素分析显示,LMR(HR 37.076,95%CI 4.691~293.037,P=0.001)和NLR(HR 9.069,95%CI 2.367~34.746,P=0.001)是影响患者PFS的独立危险因素。Cox单因素分析显示,IPI评分(P=0.034)、ECOG行为评分(P=0.016)、NLR(P=0.025)和LMR(P=0.010)与睾丸原发性DLBCL患者OS有关,多因素分析显示,LMR(HR 0.077,95%CI 0.008~0.760,P=0.028)和ECOG行为评分(HR 20.013,95%CI 1.431~279.876,P=0.026)是影响患者OS的独立危险因素。结论NLR高值、LMR低值是影响睾丸原发性DLBCL患者预后的独立危险因素。

Objective To investigate the prognostic value of neutrophil-to-lymphocyte ratio(NLR)and lymphocyte-to-monocyte ratio(LMR)for patients with primary testicular diffuse large B-cell lymphoma(DLBCL).Methods A total of 28 patients with primary testicular DLBCL who admitted in our hospital from January,2005 to January,2015 were enrolled in the study.Receiver operating characteristic curve(ROC)curve was performed to identify the optimal thresholds for NLR and LMR in the summit of Youden index.The patients were divided into the high and low ratio groups,according to this node.Kaplan-Meier method,univariate and multivariate Cox regression analyses were conducted to analyze the relationship between NLR,LMR and the progression-free survival(PFS)and overall survival(OS)of primary testicular DLBCL patients.Results The threshold values of LMR for PFS and OS were 3.39 and 3.31.The threshold values of NLR for PFS and OS were 2.49 and 2.66.The PFS of NLR≤2.49 group was higher than that of NLR>2.49 group(P=0.003).The PFS of LMR>3.39 group was higher than that of LMR≤3.39 group(P=0.004).The OS of NLR≤2.66 group was higher than that of NLR>2.66 group(P=0.025).The OS of LMR>3.31 group was higher than that of LMR≤3.31 group(P=0.010).Univariate analysis showed that IPI score(P=0.010),serum LDH level(P=0.017),neutrophil count(P=0.018),monocyte absolute count(P=0.001),NLR(P=0.003),LMR(P=0.004)and SII(P=0.005)were prognostic factors affecting PFS.Multivariate analysis showed that LMR(HR 37.076,95%CI4.691-293.037,P=0.001)and NLR(HR 9.069,95%CI 2.367-34.746,P=0.001)were prognostic factors affecting PFS.Univariate analysis showed that IPI score(P=0.034),ECOG behavior score(P=0.016),NLR(P=0.025)and LMR(P=0.010)were prognostic factors affecting OS.Multivariate analysis showed that LMR(HR 0.077,95%CI 0.008-0.760,P=0.028)and ECOG behavior score(HR 20.013,95%CI 1.431-279.876,P=0.026)were prognostic factors affecting OS.Conclusion High NLR and low LMR can serve as independent risk factors for the prognosis of patients with primary testicular DLBCL.