乳酸脱氢酶/淋巴细胞绝对值对弥漫大B细胞淋巴瘤患者预后的影响

Influence of lactate dehydrogenase to absolute lymphocyte count ratio on prognosis of patients with diffuse large B-cell lymphoma

目的探讨乳酸脱氢酶(LDH)/淋巴细胞绝对值(ALC)比值(LAR)对弥漫大B细胞淋巴瘤(DLBCL)患者预后的影响。方法选择该院2014年5月7日至2021年5月26日确诊的DLBCL患者50例,收集所有患者首次化疗前1周内的静脉血LDH及ALC,计算出LAR。利用χ2检验分析LAR与各临床病理参数的关系。应用生存分析研究LAR对DLBCL患者无进展生存率(PFS)的影响。绘制受试者工作特征(ROC)曲线,分析国际预后指数(IPI)及其联合LAR对DLBCL患者PFS的预测效能。结果DLBCL患者LAR与IPI和Ann Arbor分期相关(P<0.05),IPI≥4分患者高LAR百分比明显高于IPI<4分患者(79.2%vs.11.5%,P<0.001),Ann Arbor分期为Ⅳ期患者高LAR百分比明显高于Ⅰ~Ⅲ期患者(56.7%vs.25.0%,P=0.027)。Kaplan-Meier生存分析显示,高LAR组和低LAR组患者2年累积PFS分别为15.8%和66.7%,差异有统计学意义(P<0.001);COX单因素分析显示,高Ki-67、高IPI、高LAR及Ann Arbor分期晚是影响DLBCL患者PFS的危险因素;多因素分析表明,LAR是影响DLBCL患者PFS的独立因素。ROC曲线显示,IPI预测DLBCL患者PFS的曲线下面积(AUC)为0.698[95%CI(0.552,0.844),P=0.017],LAR联合IPI预测DLBCL患者PFS的AUC为0.754[95%CI(0.615,0.893),P=0.002]。结论LAR对DLBCL患者预后具有重要影响,可作为判断DLBCL患者PFS的指标,且联合IPI预测效能更好。

Objective To explore the effect of lactate dehydrogenase(LDH)to absolute lymphocyte count(ALC)ratio(LAR)on the prognosis of the patients with diffuse large B-cell lymphoma(DLBCL).Methods Fifty cases of patients definitely diagnosed with DLBCL in this Hospital from May 7,2014 to May 26,2021 were selected.The venous blood LDH and ALC within 1 week before the first chemotherapy in all patients were collected to calculate the LAR value.The Chi square test was used to analyze the relationship between LAR and clinicopathological parameters.The impact of LAR on the progression free survival rate(PFS)of the patients with DLBCL was studied by the survival analysis.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficiency of the International Prognostic Index(IPI)and its combination with LAR for PFS in the patients with DLBCL.Results LAR in the patients with DLBCL was correlated with IPI and the Ann Arbor stage(P<0.05).The percentage of high LAR of the patients with IPI≥4 points was significantly higher than that of the patients with IPI<4 points(79.2%vs.11.5%,P<0.001).The percentage of high LAR of the patients with Ann Arbor stageⅣwas significantly higher than that of the patients with stageⅠ-Ⅲ(56.7%vs.25.0%,P=0.027).The Kaplan-Meier survival analysis showed that the 2-year cumulative PFS of the patients in the high LAR group and low LAR group were 15.8%and 66.7%,respectively,and the difference was statistically significant(P<0.001).The COX univariate analysis showed that high Ki-67,high IPI,high LAR and late Ann Arbor stage were the risk factors for PFS in the patients with DLBCL.The multivariate analysis indicated that LAR was an independent factor affecting PFS in the patients with DLBCL.The ROC curve revealed that the area under curve(AUC)of IPI for predicting PFS of the patients with DLBCL was 0.698[95%CI(0.552,0.844),P=0.017],and AUC of LAR combined with IPI for predicting PFS in the patients with DLBCL was 0.754[95%CI(0.615,0.893),P=0.002].Conclusion LAR has an important impact on the prognosis of the patients with DLBCL and could be used as an indicator for predicting PFS of the patients with DLBCL.Furthermore,its combination with IPI has good predictive efficiency.