| Objective:Exploring the effect of prognostic nutritional index(PNI)on overall survival(OS)and progression free survival(PFS)of patients with diffuse large B-cell lymphoma(DLBCL).Methods:We collected 43 DLBCL patients’ clinical data.All the patients were treated in the First Hospital of Shanxi Medical University from January 1st,2018 to January31 st,2022.The prognosis of the patients was known through outpatient or telephone follow-up.Firstly,we tried to get the optimal cutoff value of PNI.Receiver operating characteristic curve was used to make the calculation.Secondly,the survival needed to be analyzed and survival curve needed to be drawn.Kaplan-Meier could be used.Next,We tried to explore the prognostic value of PNI in DLBCL patients.Meanwhile,we could explore other clinical characteristics on how to affect the OS and PFS in DLBCL patients.We explored whether the clinical characteristics of DLBCL patients in different PNI groups had some differences by using chi-square test for inter-group comparison.Result:1.There were 43 DLBCL patients in this study.The proportion of males was relatively large and the number of them was 23(53.5%).The median age was 60 years old,and 21 patients were older than 60 years old(48.8%).There were 21 patients with Ann Arbor stage I-II(48.8%)and 22 patients with Ann Arbor stages III-IV(51.2%).22 patients were newly diagnosed with B symptoms(51.2%).There were 18 patients who had scores more than 2 in the Eastern Cooperative Oncology Group(ECOG)score(41.9%).There were 21 patients whose International Prognostic Index(IPI)was more than 2 scores(48.8%).There were 15 patients who were nodal DLBCL(34.9%),and there were 28 patients who were extra-nodal DLBCL(65.1%).There were 10 patients whose Lactate dehydrogenase(LDH)was increased(23.3%).There were 28 patients whose D-dimer was increased(65.1%).There were 22 patients suffered from Germinal Center B-cell(GCB)(51.2%).On the contrary,21 patients suffered from non-Germinal Center B-cell(non-GCB)(48.8%).There were 19 patients whose Ki-67 was more than 80%(44.2%).There were 20 patients with C-MYC,BCL-2 and/or BCL-6 gene mutation(46.5%).2.All the patients received regular R-CHOP treatment for 6-8 cycles.Among them,4 elderly patients were treated with low-dose R-mini CHOP.After treatment,24 patients could reach complete remission(CR)(55.8%).During the study,we used26 months as the median follow-up time.In the end,we finished our follow-up in June 30 th,2022.We could get the conclusion that the patients’ OS rate was 77.7%,it was 95.2% when the survival time was one year,while it was 77.7% when the survival time was three years.The total PFS rate was 39%.We found that the median PFS was 41 months.Furthermore,there was a result that the PFS rate was 66.1%when the survival time was one year,while it was 52.0% when the survival time was three years.3.The single factor analysis showed that less than 39.4 of PNI(P<0.001),increased LDH(P=0.010),greater than or equal to 80% of Ki-67(P=0.026),greater than or equal to 2 points of IPI(P=0.045),greater than or equal to 2 points of ECOG(P=0.037),and non-GCB subtypes of cell origin(P=0.036)were adverse prognostic factors affecting the OS in DLBCL patients.As for the PFS,the DLBCL patients were affected by the factors such as less than 39.4 of PNI(P<0.001),increased D-dimer(P=0.037),greater than or equal to 2 points of IPI(P=0.007),non-GCB subtype of cell origin(P=0.031),mutation of C-MYC,BCL-2 and/or BCL-6 gene(P=0.027).4.The above factors that had statistical significance on the OS of DLBCL patients were studied by COX multivariate analysis,including less than 39.4 of PNI,the increasing of LDH,greater than or equal to 80% of Ki-67,greater than or equal to2 points of IPI,greater than or equal to 2 points of ECOG,and the cell origin of non-GCB subtype.The results showed that,less than 39.4 of PNI was an independent adverse prognostic factor affecting OS in DLBCL patients(P=0.034).Statistically significant factors influencing the PFS of DLBCL patients were studied,including less than 39.4 of PNI,D-dimer elevation,greater than or equal to 2 points of IPI,with C-MYC 、BCL-2 and/or BCL-6 gene mutation and non-GCB subtype of cell origin.COX multivariate analysis showed that,less than 39.4 of PNI was an independent adverse prognostic factor affecting the PFS in DLBCL patients(P=0.04).5.Research results combining PNI and other clinical characteristics of DLBCL patients showed that,differences of Ki-67(P=0.025),IPI(P=0.009),ECOG(P=0.015),and CR rate after treatment(P=0.025)in different PNI groups were statistically significant.However,as for the sex,age,LDH,D-dimer,onset sites,with or without B symptoms,Ann Arbor stage,the origin of cell origin,with or without C-MYC 、 BCL-2 and/or BCL-6 gene mutation,the differences have no statistical significance(P>0.05).Conclusion:1.Low PNI was an independent adverse prognostic factor affecting the OS and PFS in DLBCL patients.2.The increase of LDH,greater than or equal to 80% of Ki-67,greater than or equal to 2 points of IPI score,greater than or equal to 2 points of ECOG score,and non-GCB subtypes were the adverse prognostic factors of OS in DLBCL patients.As for the PFS,DLBCL patients were influenced by these adverse factors,such as D-dimer elevation,greater than or equal to 2 of IPI score,non-GCB subtype,with C-MYC,BCL-2 and/or BCL-6 genes mutation.3.The differences of Ki-67,IPI score,ECOG score and CR rate after treatment in DLBCL patients in different PNI groups were statistically significant. |
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