Comparison of the Prognostic Impact of Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio, and Glasgow Prognostic Score in Diffuse Large B-Cell Lymphoma

Abstract

Background: Given the role of inflammation in tumor progression, as well as in diffuse large B-cell lymphoma (DLBCL), researchers are trying to identify easily applicable, easy accessible prognostic markers for individual risk assessment. The most frequently used inflammatory prognostic markers are the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the Glasgow prognostic score (GPS). Objectives: To determine and compare the prognostic value of the baseline inflammatory biomarkers NLR, PLR, and GPS in patients with DLBCL. Methods: We retrospectively analyzed data from 103 DLBCL patients treated with R-CHOP or R-CHOP-like regimens. We evaluated the significance of NLR, PLR, and GPS as a predictor of response to treatment, overall survival (OS), and event-free survival (EFS). Results: Higher NLR levels were found in patients with a poorer response to therapy (median [range] 2. 87 [0.56 -26.33] vs. 4 [0.62 -29.66], P = 0.026). Patients with NLR values of > 2.63 (cutoff value calculated by receiver-operating characteristic) had significantly worse two-year OS (65.1% vs. 87.2%, P = 0.002) and two-year EFS (59.8% vs. 87.1%, P = 0.001). PLR values were not significant for survival. The two-year OS rates for patients with GPS = 0, GPS = 1, and GPS = 2 were 93.3%, 63.9%, and 33.3%, respectively (P < 0.001), and EFS rates were 86.5%, 65.3%, and 30.3%, respectively (P < 0.001). Cox regression analysis showed that only NLR values of > 2.63 were an independent prognostic factor for OS (hazard ratio [HR] = 2.857; 95% confidence interval [CI] 1.022 -8.699; P = 0.048] and EFS (HR = 4.06; 95% CI 1.357 -12.151; P = 0.012). Conclusions: Our research confirmed NLR as useful independent prognostic marker for survival. PLR and GPS did not show independent prognostic value, although they were also associated with the patients' clinical features. The easy availability and inexpensiveness of inflammatory biomarkers should encourage their use in clinical practice.

Prognostic role of the neutrophil-to-lymphocyte ratio in patients with primary central nervous system lymphoma

“…Considering this possible origin of PCNSL, systemic inflammation still could be assumed to affect the development of PCNSL. In our data, NLR 2.0 was identified as a relatively sensitive and specific point to discriminate high NLR and low NLR groups, but in most previous studies on DLBCL, an NLR of 3.0 to 5.0 was used as the distinguishing point [ 3 , 9 , 10 , 13 , 15 ]. The relatively low NLR cutoff in our data might reflect that PCNSL could develop in a relatively less severe inflammatory environment or even in an immune-deficient condition.…”

Prognostic impact of platelet-to-lymphocyte ratio on diffuse large B-cell lymphoma: a meta-analysis

“…Six studies were conducted in China [12, 14–16, 22, 23], one in Austria [11] and one in Croatia [13]. Five studies were published in English [11, 13, 14, 16, 22] and three in Chinese [12, 15, 23]. The total sample size was 1931, ranging from 59 to 515.…”

“…The cut-off values of PLR ranged from 143 to 435. Five studies [11–13, 16, 22] employed R-CHOP regimen and three studies [14, 15, 23] used R-CHOP/CHOP regimen. All eight studies [11–16, 22, 23] reported the prognostic value of PLR on OS and seven studies [12–16, 22, 23] showed the association of PLR and PFS.…”

Prognostic role of the neutrophil‐to‐lymphocyte ratio in patients with primary central nervous system lymphoma

“…Considering this possible origin of PCNSL, systemic inflammation still could be assumed to affect the development of PCNSL. In our data, NLR 2.0 was identified as a relatively sensitive and specific point to discriminate high NLR and low NLR groups, but in most previous studies on DLBCL, an NLR of 3.0 to 5.0 was used as the distinguishing point [3,9,10,13,15].…”

“…In recent years, many inflammatory markers such as NLR, PLR, RDW, and fibrinogen have been suggested as prognostic markers for various malignancies [3][4][5][6][7][8][9][10][12][13][14]. Ho et al also revealed that the absolute lymphocyte count-to-absolute monocyte count prognostic score (ALC/AMC PS) might provide additional prognostic information to the International Prognostic Index (IPI) for DLBCL [15].…”