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

Abstract

Neutrophil-to-lymphocyte ratio (NLR) is one of the parameters of a complete blood cell count (CBC) test and has been reported to be an easily accessible prognostic marker in aggressive cancer, including non-Hodgkin lymphoma (NHL). Primary central nervous system lymphoma (PCNSL) is an extranodal NHL with highly aggressive features. However, the importance of the NLR has never been assessed in PCNSL. This retrospective study enrolled 62 biopsy-proven patients whose baseline NLR was available, and reviewed their medical records to compare both high (≥2.0) and low NLR (<2.0) groups, in terms of clinical characteristics and outcomes. The low NLR group showed significantly better response rates to induction chemotherapy compared to the high NLR group (p=0.041). At a median follow-up of 41.5 months, the high NLR group revealed a significantly worse 3-year overall survival (OS) (42.5 vs. 71.2%; p=0.031) and a worse 3-year progression-free survival (PFS) (37.3 vs. 60.1%; p=0.028). Univariable Cox analysis results showed that a high NLR at diagnosis was a poor prognostic factor for both 3-year OS (HR 2.64, 95% CI 1.06-6.60; p=0.038) and 3-year PFS (HR 2.41, 95% CI 1.07-5.42; p=0.034). However, multivariable analyses adjusting for International Extranodal Lymphoma Study Group (IELSG) score and induction chemotherapy regimen with rituximab, which were strongly prognostic in this study, showed no statistical significance even with the high NLR group’s tendency towards a worse 3-year OS (HR 2.36, 95% CI 0.84-6.62, p=0.102) and a worse 3-year PFS (HR 2.28, 95% CI 0.93-5.63, p=0.073). In conclusion, given that NLR is simple and easily obtainable, it might play a potentially prognostic role in PCNSL from early disease onset.

Pretreatment Hemoglobin as an Independent Prognostic Factor in Primary Central Nervous System Lymphomas

“…We did not find any statistically significant association between neutrophil, lymphocyte, or platelets or their ratios like NLR and PLR, as has been previously suggested in other studies in in solid tumors as well as in brain tumors, DLBCL, and PCNSL [8, 10, 20-22, 32, 33]. A recent retrospective study analyzing the potential prognostic impact of NLR in a cohort of 62 patients with PCNSL showed that high NLR (≥2) was associated with poor prognosis in univariate analysis but not in multivariate analysis [10]. In the same line, there are contradictory results regarding the impact of NLR in DLBCL [21,22,34].…”

<p>The Neutrophil to Lymphocyte and Lymphocyte to Monocyte Ratios as New Prognostic Factors in Hematological Malignancies – A Narrative Review</p>

“…This may be one of the reasons why upwards of 15% malignancies worldwide are initiated by infections. 33 In summary, the main cells, promoting immunodeficiency are regulatory T (Treg) lymphocytes marked by Foxp3+, myeloid-derived suppressor cells (MDSC) marked by HMGB1 and M2 macrophages marked by CD163+. 17,[34][35][36] Granulocytes may also promote cancer development by inducing alterations in stromal cells and through the expression of cytokines, such as hematopoietic growth factor (HGF) and granulocyte colony-stimulating factor (G-CSF).…”

“…72 NLR is also under investigation. In Jung et al 33 study, 39 patients with primary central nervous system lymphoma were divided into a high NLR group and a low NLR group. The cut-off value was established for 2.…”

“…What is interesting, is the impact of systemic inflammation on development of PCNSL. 33 As we know central nervous system is devoid of lymphoid aggregation. The role of NLR, PLR and RDW suggests that systemic inflammation could affect PCNSL.…”

Can Neutrophil/Lymphocyte Ratio be Used As a Marker in The Diagnosis of Bullous Pemphigoid

“…Neutrophil lymphocyte ratio (NLR) is a whole blood count test that is obtained by dividing the total number of neutrophils by the total lymphocyte count, and it has been reported that it can be an easily calculated parameter in indicating systemic inflammation (11,12). It is known that NLR is increased in many diseases such as malignancies, diabetes and myocardial infarction (13)(14)(15). Although BP is a disease in which inflammation takes part in its etiology, to our knowledge, there is no previous study in the literature investigating the relationship of NLR with this disease.…”