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Original Article
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
Kosin Medical Journal 2016;31(2):122-133.
DOI: https://doi.org/10.7180/kmj.2016.31.2.122
Published online: January 20, 2016

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: January 9, 2015   • Accepted: June 3, 2015

Copyright © 2016 Kosin University School of Medicine Proceedings

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.

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  • 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
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
kmj-31-122f1.jpg
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
kmj-31-122f2.jpg
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
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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    • Prognostic Role of Neutrophil to Lymphocyte Ratio at Diagnosis in Patients with Diffuse Large B-Cell Lymphoma
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      Nigerian Journal of Clinical Practice.2024; 27(8): 1012.     CrossRef
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      Cancer Cell International.2018;[Epub]     CrossRef

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      Prognostic Significance of Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Diffuse Large B-Cell Lymphoma Patients Treated with R-CHOP
      Kosin Med J. 2016;31(2):122-133.   Published online January 20, 2016
      DOI: https://doi.org/10.7180/kmj.2016.31.2.122
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    Prognostic Significance of Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Diffuse Large B-Cell Lymphoma Patients Treated with R-CHOP
    Image Image
    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

    Fig. 1.

    Fig. 2.

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

    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)

    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

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

    Value PFS OS
    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
    Table 1. Patient characteristics

    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

    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

    Table 1.

    Table 2.

    Table 3.

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