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

Abstract

Background: Pretreatment nutritional status has been noted to be an important prognostic factor in various types of malignancies, but its prognostic significance is not still investigated in diffuse large B-cell lymphoma (DLBCL) patients in the rituximab era.Method: A retrospective cohort of 297 patients with newly diagnosed DLBCL treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) were analyzed to reveal the prognostic significance of the controlling nutritional status (CONUT) score. The CONUS was calculated by the serum albumin concentration, the total peripheral lymphocyte count, and the total cholesterol concentration, which has been developed to screen nutritional status in the early stage of the diseases.Result: The mean follow-up duration was 39.9 months (95% confidence interval [CI], 36.7-43.3 months). At a CONUS cutoff of <2 vs ≥ 2, a trend towards longer 5-year progression-free survival (PFS, CONUS 0 vs 1/2, 76.5% vs 63.6%, respectively; P = .088) was observed in all of the treated patients. In germinal center (GC) type subgroup, the lower CONUS group showed a significantly longer 5-year PFS (CONUS 0 vs 1/2, 80.1% vs 69%, respectively; P = .048).Five-year PFS and overall survival (OS) were significantly better in patients with the lower Glasgow prognostic score (GPS), the lower Ann Arbor stage, the better Eastern Cooperative Group (ECOG) performance status, and the lower international prognostic indices (IPI).In multivariate analysis, the lower international prognostic indices was the only significant poor prognostic factor for PFS (hazard ratio[HR], 2.56; 95% confidence interval [CI], 1.33-4.91; P = .005), but for OS, the GPS (HR, 2.1; 95% CI, 1.07-4.51; P = .019) and the ECOG performance status (HR, 2.2; 95% CI, 1.07-4.51; P = .33) were significant prognostic factors. Conclusion: Pretreatment nutritional status calculated by the CONUShas the possibility of predictive value of progression-free survival in DLBCL patients treated with rituximab-based regimen, especially in GB type patients.