Prognostic value of lymphocyte-to-monocyte ratio and neutrophil-to-lymphocyte ratio in follicular lymphoma: a retrospective cohort study

Abstract

ObjectivesThe clinical course and prognosis of follicular lymphoma (FL) are diverse and associated with the patient’s immune response. We investigated the lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) as prognostic factors in patients with FL, including those receiving radiotherapy.DesignA retrospective cohort study.SettingRegional cancer centre in Hong Kong.Participants88 patients with histologically proven FL diagnosed between 2000 and 2014.Materials and methodsThe best LMR and NLR cut-off values were determined using cross-validated areas under the receiver operating characteristic curves. The extent to which progression-free survival (PFS) and overall survival differed by NLR and LMR cut-off values was assessed using Kaplan-Meier analysis and log-rank tests. A Cox proportional hazards model was fitted to adjust for confounders.ResultsThe best cut-off values for LMR and NLR were 3.20 and 2.18, respectively. The 5-year PFS was 73.6%. After multivariate adjustment, high LMR (>3.20) at diagnosis was associated with superior PFS, with a HR of 0.31 (95% CI 0.13 to 0.71), whereas high NLR at relapse was associated with poorer postprogression survival (HR 1.24, 95% CI 1.04 to 1.49).ConclusionsBaseline LMR and NLR at relapse were shown to be independent prognostic factors in FL. LMR and NLR are cheap and widely available biomarkers that could be used in combination with the Follicular Lymphoma International Prognostic Index by clinicians to better predict prognosis.

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

“…Additionally, monocyte chemoattractant protein plays important role in modulating tumorigenesis. 19,26 TNF α and IL-1, which are also secreted from monocytes, are associated with poor prognosis in cancer patients. 27 Thus, monocytes play an important role in tumor microenvironment and might be considered as markers of a prolific tumor burden.…”

“…51 As FLIPI does not always reflect patient's survival in the age of modern therapy, new prognostic strategies, for example based on tumor microenvironment parameters, are needed. 26 As it is believed that serum leucocyte levels reflect tumor microenvironment, studies has been conducted, considering the relationship of absolute monocyte count (AMC) as well as absolute lymphocyte count (ALC) and FL patient's outcomes. Wilcox et al 52 found a positive correlation between OS and AMC (AMC cut off value has been calculated 0•57 × 10 9 cells/ l).…”

“…55 In comparison with DLBCL, there is less evidence for prognostic value of NLR in FL. Lee et al 26 performed retrospective cohort study, in which 88 patients with FL took part. LMR and NLR were evaluated as valuable prognostic factors.…”

“…Authors conclude that LMR and NLR values might be used alongside with FLIPI, to achieve credible prognostic information. 26 Belotti et al 56 revealed that FL patients with LMR above 2 had longer time to treatment compared with those with LMR below 2. 2-year PFS in patients treated with rituximab was superior in the LMR above 2 group.…”

Importance of neutrophil-lymphocyte ratio in the management of children with cervical lymphadenopathy

“…The differentiation of malignant from benign causes is critically important, and so increasing the armamentarium of additional predictive factors and findings that would alert the clinician would be beneficial in the clinical follow-up of pediatric patients with cervical LAP. In the literature, there have been studies demonstrating the vital prognostic significance of the neutrophil-lymphocyte ratio (NLR) in lymphoid system cancers such as Hodgkin lymphome (8,9), diffuse B-cell lymphome (10,11) and follicular lymphoma (12). These results suggests that an increase in NLR could be related to tumor growth in lymphadenopathy.…”