Prognostic Analysis Of LMR And NLR In Newly Diagnosed Diffuse Large B-cell Lymphoma Patients

Objective: To investigate the prognostic value of lymphocyte count to monocyte count ratio(LMR)and neutrophil count to lymphocyte count ratio(NLR)in patients with primary diagnosis of diffuse large B-cell lymphoma(DLBCL).Methods: The clinical data of 108 patients with diffuse large B-cell lymphoma initially diagnosed and treated at Jilin Cancer Hospital from February 2013 to October 2020 were retrospectively analyzed,including age,gender,Hans’ staging,number of extra-nodal invasion,Ann Arbor stage,IPI score,ECOG score,B symptoms,LDH,LMR,NLR,LMR after 4-8 cycles of treatment,and During the statistical analysis,subject operating characteristic curves(ROC curves)were used,the best cut-off values for LMR and NLR were calculated and grouped,and the correlations of clinical characteristics of LMR and NLR between different groups were compared using the chi-square test;the Kaplan-Meier method was used to plot the survival curves of PFS and OS for LMR and NLR in different groups.Log-rank test and Cox regression model were used to analyze the univariate and multifactorial factors affecting PFS and OS in DLBCL patients.P<0.05 in this study indicates that the difference is statistically significant.Results: The optimal cutoff values of LMR and NLR were calculated as 3.28 and 3.02 respectively by ROC curve,and they were grouped(low/high LMR group,low/high NLR group).Chi-square test was used to compare clinical features.Low LMR group(< 3.28)was associated with more exodal invasion,Ann Arbor stage Ⅲ-Ⅳ,ECOG score 2-5,LDH level higher than normal,IPI score 3-5 and B symptoms(P < 0.05).High NLR group(> 3.02)was associated with Ann Arbor stage Ⅲ-Ⅳ,higher LDH level than normal,and IPI score3-5 points(P < 0.05).The 3-year PFS and OS rates in the low LMR group were 60% and65%,respectively,and those in the high LMR group were 82% and 86%,respectively.The3-year PFS and OS rates in the high LMR group were higher than those in the low LMR group(P < 0.001,P < 0.001).The 3-year PFS and OS rates were 84% and 92% in the low NLR group,and 42% and 36.9% in the high NLR group,respectively.The 3-year PFS and OS rates in the low NLR group were higher than those in the high NLR group(P=0.002,P< 0.001).In the low LMR group,there was no statistical significance in PFS and OS between the two groups after 4-8 cycles of treatment(P=0.730,P=0.352).In the high LMR group,there was no statistical significance in PFS and OS between the two groups after 4-8cycles of treatment(P=0.753,P=0.575).Single factor analysis using Log-rank test showed that low LMR and high NLR were risk factors for PFS survival and prognosis in DLBCL patients,and the difference was statistically significant(P < 0.05).Ann Arbor stage III and IV,symptoms of B,IPI score 3-5,ECOG score 2-5,high LDH,low LMR and high NLR were risk factors affecting the survival and prognosis of OS in DLBCL patients,and the difference was statistically significant(P < 0.05).Multivariate analysis of Cox proportional risk model showed that low LMR was an independent risk factor for the survival and prognosis of PFS in DLBCL patients(P < 0.05),and B symptoms and low LMR were independent risk factors for the survival and prognosis of OS in DLBCL patients(P < 0.05).Conclusion: LMR is an independent risk factor for survival prognosis of DLBCL patients.NLR is a risk factor for survival prognosis of DLBCL patients,but not an independent risk factor.