Prognostic Significance of Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Diffuse Large B-Cell Lymphoma Patients Treated with R-CHOP

Lee Chun Park; Ho Sup Lee; Eun Mi Lee; Seong Hoon Shin; Yang Soo Kim

doi:10.7180/kmj.2016.31.2.122

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Park, Lee, Lee, Shin, and Kim: Prognostic Significance of Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Diffuse Large B-Cell Lymphoma Patients Treated with R-CHOP

Original Article

Kosin Medical Journal 2016;31(2):122-133.

Published online: 20 January 2016

DOI: https://doi.org/10.7180/kmj.2016.31.2.122

Prognostic Significance of Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Diffuse Large B-Cell Lymphoma Patients Treated with R-CHOP

Lee Chun Park, Ho Sup Lee, Eun Mi Lee, Seong Hoon Shin, Yang Soo Kim

Department of Internal Medicine, College of Medicine, Kosin University, Busan, Korea

Corresponding Author: Yang Soo Kim, Department of Internal Medicine, College of Medicine, Kosin University, 262, Gamcheon-ro, Seo-gu, Busan 49267, Korea Tel: +82-51-990-5820 Fax: +82-51-990-5820 E-mail: 2000p@hanmail.net

Received 9 January 201516 April 2015 Accepted 3 June 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

The both values of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) were reported as indexes of systemic inflammation and readily available and inexpensive prognostic markers in patients with solid cancer. The objective of this study was to clarify whether the NLR and PLR were significant prognostic markers in Korean diffuse large B-cell lymphoma (DLBCL) patients treated with R-CHOP as a first line therapy.

Methods

: We retrospectively collected the clinical data of ninety nine DLBCL patients treated with R-CHOP from 2004 to 2012 and analyzed. NLR and PLR were calculated from complete blood count (CBC) and differential leukocyte count.

Results

: In univariate analysis, NLR was significantly associated with 5-year progression free survival(PFS) rate (P= 0.039), but not significantly associated with 5-year overal survival (OS) rate (P= 0.276). PLR was not significantly associated with 5-year PFS (P= 0.632) and OS rate (P= 0.855). In multivariate analysis, NLR was not a significant independent prognostic factor for 5-year PFS (P= 0.415) and OS rate (P= 0.991).

Conclusion

: The NLR can be considered a useful predictor of survival outcome. The PLR is not a valid predictor of survival outcome.

Keywords: DLBCL, NLR, PLR, Prognostic factor

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Fig. 1.

Five years progression free survival curves and overall survival curves according to Neutrphil/lymphocyte ratio in patients with diffuse large B-cell lymphoma. a. Five years progression free survival curves b. Five years overall survival curves

Fig. 2.

Five years progression free survival curves and overall survival curves according to Platelet/lymphocyte ratio in patients with diffuse large B-cell lymphoma. a. Five years progression free survival curves b. Five years overall survival curves

Table 1.

Patient characteristics

Value (%)	N=99
Age, years Median (range)	60 (32—81)
Gender (%) Male Female	53 (53.5) 46 (465%
IPI (%) Low Low-intermediate High-intermediate High	37 (37.4) 28 (28.3) 13 (13.1) 21 (21.2)
LDH Normal PIqude	39 (39.4) m (60 6\
ECOG (%) 0 — 1 > 7.	61 (61.6) 28 (18M
Stage (%) < 111 2 III	46 (46.5) 53 (53.5)
Extranodal involvement (%) < 2 > 7	84 (84.8) 14″ R″N
Bulky mass (%) < 10 cm 2 10 cm	88 (88.9) 11 (11.1)
CRP, mg/dL Mean (range)	2.25 (0.01 — 19.151
B2-microglobulin, mg/L Mean (ran 9e}	2.45 (0.87 — 9.6m
BM involvement (%) Present Absent	16(16.2) 2? (mm
ALC, x 103/mL Mean (range)	I770 (40 — 2236M
Ferritin, ng/mL Mean (range)	334.76 (7.90 — 4872.40)
Neut/lymph ratio Mean (range)	3.53 (0.05 — 31.85)
PLT/lymph ratio Mean (range)	302.52 (12.61 — 7100.00)

IPI, international prognostic index; LDH, lactate dehydrogenase; ECOG, Eastern Cooperative Oncology Group (ECOG) oerformance status: CRP. C-reactive Drotein: BM. bone marrow: ALC. absolute lvmohocvte counts:

Table 2.

Prognostic factors for survival in patients with DLBCL by univariate analysis

Value	Syrs PFS (%)	P-Value	Syrs OS (%)	P-Value
Age, yrs < 60 > 60	71.6 67 7	0.094	70.8 66 4	0.231
Gender Male Female	66.8 65.5	0.472	63.2 72.2	0.265
IPI Low/low-intermediate Hi 0h-inf9ﬁn9dintP/hi oh	73.8 en a	0005∗	75.3 «I 1	0001∗
LDH, (IU/L) < 450 > A 4n	74.0 £1 <	0.119	82.3 (A 7	0.008∗
ECOG (%) < 2 > 2	70.1 57.5	0.322	73.6 65.9	0.809
Stage (%) < 111 2 III	82.5 51.4	0014∗	85.9 50.5	0007∗
Extranodal involvement (0/: < 2 > 7.	65.3 710	0.529	67.3 658	0.926
Bulky mass (%) < 10 cm 210 cm	67.3 62.3	0.858	68.4 62.2	0.770
CRP, mg/dL < 0.8 > n 52	81.8 <76	0005∗	82.9 H 7	0001∗
BZ-microglobulin, mg/L < 2.5 > 7 <	74.7 m 7	< 0.001"	77.8 M 1	0.001∗
BM involvement (%) Present Absent	47.7 69.8	0045∗	49.7 71.5	0.164
ALC, 1.0 x105/uL < 1000 2 1000	69.4 67.6	0.696	81.5 65.0	0.390
Ferritin, ng/ml < 500 > €00	70.3 $1 2	0024∗	72.3 46 7	0.004∗
Neut/lymph ratio < 3.50 > 3.50	67.9 51.7	0039∗	71.1 63.0	0.276
PLT/lympho ratio < 150 150∼3 00 > 300	70.8 67.7 60.1	0.632	67.7 71.4 65.0	0.855

IPI, international prognostic index;LDH, lactate dehydrogenase; ECOG, Eastern Cooperative Oncology Grou (ECOG) nerformance statuszCRP. C-reactive nrotein: BM. bone marrow: ALC. absolute lvmnhocvte counts

Table 3.

Independent prognostic factors for survival in patients with DLBCL by multivariate analysis

Value	PFS			OS
Value	RR	95% Cl	p-value	RR	95% Cl	p-value
IPI Low & low-intennediate	0 R70	0 746–201?	0 217	n 600	0711—7 745%	0 S20
Hinwh-intennediate X; high
CRP, mg/dL < 0.8 > 0 R	I 107,	0 781–479?	0 289	0591	OHSJSQ')	048$
BZ-microglobulin, mg/L < 2.5 2 2.5	0.195	0064–0595	0004∗	0.285	0087–0936	0039∗
BM involvement (%) Present Absent	1.637	0.442—6063	0.461
F erritin, ng/mL < 500 > 500	0.434	0.118-l.601	0.210	0.458	0.146–1.438	0.181
Neut/lympho ratio < 3.50 2 3.50	0.619	0.195–1.96C	0.415	0.987	0333–2948	0.991

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