Clinical Characteristics,curative Efficacy And Prognosis Analysis Of Primary Central Nervous System And Systemic Diffuse Large B-Cell Lymphoma

Objective: To examine the clinical features,curative efficacy,and prognostic variables influencing the progression-free survival(PFS)and overall survival(OS)of 114 patients with newly diagnosed diffuse large B-cell lymphoma(68 systemic diffuse large B-cell lymphoma and 46 primary central nervous system diffuse large B-cell lymphoma).Methods: Retrospective analysis of 114 patients with diffuse large B-cell lymphoma(DLBCL)clearly diagnosed by pathology from August 1,2014 to June 30,2022 in our center,recording the patients’ clinical characteristics,laboratory indices,treatment regimens,efficacy,and survival status.The optimal cut-off values for platelet lymphocyte ratio(PLR)and neutrophil lymphocyte ratio(NLR)were calculated using the subject operating characteristic(ROC)curves,and patients were grouped according to the optimal cut-off values to compare the clinical characteristics and prognosis of the high PLR and low PLR groups,the high NLR and low NLR groups.In addition,realtime fluorescence quantitative PCR and first-generation sequencing technologies were used to discover mutations in the My D88L265 P and CD79 B genes in tumor samples from 18 patients with primary central nervous system diffuse large B-cell lymphoma(PCNSL-DLBCL).Metrics that may be associated with first PFS and OS in systemic DLBCL and PCNSL-DLBCL were analyzed.Results: Clinical characteristics such as age,gender,serum LDH,plasma β2-MG,and serum ALB levels were not statistically different between patients with systemic DLBCL and PCNSL-DLBCL(P > 0.05).Compared with systemic DLBCL,patients with PCNSL-DLBCL had worse physical fitness status(ECOG)(P =0.027)and lower levels of PLR and NLR(P =0.002,P <0.001).The 2-treatment ORR was 32.8% and63.9% in patients with systemic DLBCL and PCNSL-DLBCL,respectively(P =0.032);the 2-year PFS rates were 58.8% and 56.2% in patients with systemic DLBCL and PCNSL-DLBCL,respectively(P =0.027),and the 2-year OS rates were 72.1% and 62.5%(P =0.034).The optimal thresholds for PLR and NLR in patients with systemic DLBCL were 267.80 and 3.45,respectively(P < 0.05),and the low PLR group(PLR ≤ 267.80)had better PFS(P = 0.010)and OS(P = 0.010)compared with the high PLR group(PLR > 267.80);compared with the high NLR(≤3.45)group had better PFS(P =0.014)and OS(P =0.024)compared with the high NLR(≤3.45)group.The Multifactorial analysis suggests that PLR(HR=0.557,95% CI=0.228-1.361,P=0.039),NLR(HR=0.683,95% CI=0.273-1.711,P =0.016)were independent prognostic risk factors affecting PFS in patients with systemic DLBCL,PLR(HR=0.744,95% CI=0.264-2.905,P =0.025),NLR(HR=1.250,95% CI=0.380-4.108,P =0.013),and serum LDH(HR=3.043,95% CI=1.093-8.470,P =0.033)were independent risk factors for OS in patients with systemic DLBCL.The optimal thresholds for PLR and NLR in PCNSLDLBCL patients were 116.72 and 3.58,respectively(P > 0.05),and no effect of each clinical feature or treatment on the prognosis of PCNSL-DLBCL was found.The tumor tissue My D88 mutation rate of 18 PCNSL-DLBCL patients was 38.9%,and the mutation sites were all L265 P,CD79B mutation rate was 33.3%,50% of the mutation sites were located in Y196,and My D88L265P/CD79 B co-mutation rate was 27.8%.The results of multifactorial analysis showed that only tumor tissue CD79 B mutation was an independent risk factor for PFS in PCNSL-DLBCL patients(P =0.026),and no effect of each clinical feature,My D88L265 P gene mutation,and CD79 B gene mutation on OS in PCNSL-DLBCL patients was found.Conclusion: 1.The heterogeneity in clinical features of DLBCL patients is significant,compared with systemic DLBCL,PCNSL-DLBCL patients have worse physical status and lower PLR and NLR;low PLR and low NLR at initial diagnosis are associated with better prognosis for systemic DLBCL patients,while PLR and NLR have no prognostic predictive effect for PCNSL-DLBCL patients.2.In the era of immun chemotherapy era,PCNSL-DLBCL patients have fair near-term outcomes but short maintenance time and poor long-term prognosis.3.The frequency of My D88L265 P and CD79 B gene mutations in PCNSL-DLBCL tumor tissues was high;the results of multifactorial analysis showed that CD79 B mutation in tumor tissues was an independent risk factor affecting PFS in PCNSL-DLBCL patients.