ObjectiveTo investigate the application of neutrophil/lymphocyte ratio (NLR) and lymphocyte/monocyte ratio (LMR) in prognostic analysis of patients with peripheral T-cell lymphoma (PTCL).
MethodsFrom July 2008 to August 2018, a total of 121 patients with PTCL diagnosed and treated in Sichuan Cancer Hospital & Institute were selected as the research subjects. Among them, there were 92 male patients and 29 females, with median age of 55 years (15-83 years). Patients′ general clinical data, laboratory test results and imaging test results were collected for retrospective analysis. The NLR and LMR were calculated based on the absolute neutrophil count, absolute lymphocyte count, and absolute monocyte count in the routine blood test results of the patient at the initial diagnosis. The optimal cut-off values of LMR and NLR were calculated from the receiver operating characteristic (ROC) curve, and patients were divided into low and high NLR groups, low and high LMR groups, according to optimal cut-off values. Chi-square test was used to compare the composition ratio of different clinical features between groups. Kaplan-Meier method was used to draw progression free survival (PFS) and overall survival (OS) curves of patients in low and high LMR groups and low and high NLR groups. Log-rank test was used to conduct univariate analysis of PFS and OS rates in PTCL patients. The influencing factors included gender, age, Ann Arbor stage, pathological type, Eastern Cooperative Oncology Group (ECOG) score, International Prognostic Index (IPI) score, Prognostic Index for PTCL (PIT) score, B symptoms, lactate dehydrogenase (LDH) level, platelets count, anemia, Ki67, NLR, LMR. Influencing factors with statistical significance in the results of univariate analysis and clinical guiding significance were included in the COX proportional hazard regression model for multivariate analysis. The procedure followed in this study was in accordance with the requirements of theDeclaration of the World Medical Association Helsinkirevised in 2013.
Results① NLR optimal cut-off value obtained by the NLR ROC curve was 3.822, the sensitivity was 0.577, the specificity was 0.623, the area under curve (AUC) was 0.591 (95%CI:0.488-0.694). LMR optimal cut-off value obtained from LMR ROC curve was 2.715, sensitivity was 0.519, specificity was 0.710, AUC was 0.614 (95%CI:0.512-0.716). ②According to the NLR optimal cut-off value, 57 patients were included in low NLR group (NLR<3 .822) and 64 patients were included in high nlr group(nlr≥3.822). clinical characteristics of patients in the two groups were not statistically significant (P>0.05). According to the LMR optimal cut-off value, 75 patients were included in low LMR group (LMR<2 .715) and 46 patients were included in high lmr group(lmr≥2.715). in low lmr group, there were 38 patients aged>60 years old and 37 patients aged≤60 years old; in high LMR group, there were 13 patients aged>60 years old and 33 patients aged≤60 years old. In low LMR group, there were 13 patients with Ann Arbor stage Ⅰ-Ⅱ, 62 cases with stage Ⅲ-Ⅳ; in high LMR group, there were 16 patients with stage Ⅰ-Ⅱ, 30 cases with stage Ⅲ-Ⅳ. There were 24 cases of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), 37 cases of angioimmunoblastic T-cell lymphoma (AITL), 14 cases of anaplastic lymphoma kinase (ALK)-anaplastic large cell lymphoma (ALCL) in low LMR group; and there were 25 cases of PTCL-NOS, 11 cases of AITL, and 10 cases of ALK-ALCL in high LMR group. Differences in age, clinical stage, and pathological type between the two groups were statistically significant (χ2=5.870, 4.764, 8.297;P=0.015, 0.029, 0.016), other clinical features were not statistically significant (P>0.05). ③ Median follow-up time of patients was 32 months (5-101 months). Median PFS time of patients in low and high NLR groups was 16 and 11 months, respectively. 3-year PFS rate of patients in low NLR group was significantly higher than that in high NLR group (28.8%vs10.2%;χ2=5.537,P=0.019). Median OS time of patients in low and high NLR groups was 56 and 19 months, respectively. 3-year OS rate of patients in low NLR group was also significantly higher than that in high NLR group (61.1%vs27.8%;χ2=9.341,P=0.002). Median PFS time of patients in low and high LMR groups was 10 and 16 months, respectively. 3-year PFS rate of patients in low LMR group was significantly lower than that in high LMR group (11.9%vs31.7%;χ2=5.391,P=0.020). Median OS time of patients in low and high LMR group was 17 and 56 months, respectivety, and 3-year OS rate of patients in low LMR group was also significantly lower than that in high LMR group (28.5%vs62.5%;χ2=8.999,P=0.003). ④ Multivariate analysis of prognostic factors in PTCL patients showed that Ann Arbor stage Ⅲ-Ⅳ (HR=0.544, 95%CI:0.314-0.944,P=0.030), ECOG>1 score (HR=0.349, 95%CI:0.221-0.551,P<0 .001), ki67≥80% (HR=0.421, 95%CI:0.253-0.699,P=0.001) and NLR≥3.822 (HR=0.615, 95%CI:0.400-0.944,P=0.026) were independent risk factors affecting PFS of patients with PTCL. Ann Arbor stage Ⅲ-Ⅳ (HR=3.632, 95%CI:1.726-7.642,P=0.001), ECOG>1 score (HR=4.311, 95%CI:2.530-7.347,P<0 .001), ki67≥80% (HR=2.691, 95%CI:1.500-4.828,P=0.001) and LMR<2 .715 (HR=0.450, 95%CI:0.265-0.764,P=0.003) were independent risk factors affecting OS of patients with PTCL.
ConclusionsNLR and LMR could be prognostic indicators for patients with PTCL. However, as this study is just a retrospective analysis research, large samples, prospective, and randomized controlled trials are needed for further research and verification of this conclusion.
