The Lymphocyte–Monocyte Ratio and the Platelet–Lymphocyte Ratio at Diagnosis as Independent Prognostic Factors in Primary Gastrointestinal Diffuse Large B Cell Lymphoma

Abstract

To study the role of the absolute lymphocyte count (ALC), absolute monocyte count (AMC), platelet count (PLT), lymphocyte-monocyte ratio (LMR) and the platelet-lymphocyte ratio (PLR) in the prognosis of primary gastrointestinal diffuse large B cell lymphoma (PGI-DLBCL). We retrospectively analyzed the prognostic value of the ALC, AMC, PLT, LMR, PLR at diagnosis in 173 PGI-DLBCL patients through histopathological examination from March 2009 to February 2015. In total, 173 patients with histopathological diagnosis of PGI-DLBCL in this study, the median age was 51 years (range 12-90 years), median follow-up time was 44 months (range 7-89 months). In univariate analysis, age <60 years, B symptoms, Lugano stage I-II, low international prognostic index (IPI) or low age-adjusted international prognostic index (aaIPI), normal lactate dehydrogenase (LDH), normal β2-microglobulin (β2m), Hb ≥ 11 g/dL, ALC ≥ 1.5 × 10/L, AMC ≤ 0.50 × 10/L, LMR ≥ 2.5, PLR ≤ 170 were related with superior overall survival (OS) and progression-free survival (PFS) ( ≤ 0.05). Multivariate analysis suggested that ALC, LMR, LDH were related with PFS ( ≤ 0.05). Similarly, age and LMR were related with OS ( ≤ 0.05). The parameters (ALC, AMC, LMR, PLR) may be valuable prognostic factors in PGI-DLBCL patients. LMR, PLR at diagnosis are expected to be independent prognostic factors for PGI-DLBCL patients.

Prognostic Significance of Pretreatment Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratio in Patients with Diffuse Large B-Cell Lymphoma

“…PLR predictive ability was also confirmed in our multivariate and univariate analysis, indicating that PLR as one prognostic factor for DLBCL patients may be more superior to NLR. Our finding was similar to the previous study [15, 16]. We assumed that the findings might be because the platelets are less stable and more resistant inflammatory markers than neutrophils; thus, the findings could better reflect the real response of host towards cancer-related inflammation [45].…”

Ratio of Immune Response to Tumor Burden Predicts Survival Via Regulating Functions of Lymphocytes and Monocytes in Diffuse Large B-Cell Lymphoma

“…Recently, the lymphocyte to monocyte ratio has been reported to be an important prognostic indicator for many malignancies, including DLBCL [11-15]. The levels of circulating lymphocytes and monocytes are reflective of both the immunological function in the peripheral blood as well as in the tumor micro-environment [22, 23].…”

“…In contrast, monocytes are considered to be negative factors for malignancy as they may infiltrate into tumor sites and differentiate into TAMs, which can promote angiogenesis, tumor proliferation, and metastasis by releasing growth factors and immune-suppressive cytokines [25, 26]. Thus, the lymphocyte-monocyte ratio reflects the immune status of the host, but more importantly, it might be able to predict the survival outcomes of patients with malignancies, as has been reported in several studies [11-15]. However, there are several limitations in using only LMR to determine patient prognosis: first of all, the survival outcomes of patients are not only influenced by the immune system, but also by some tumors’ intrinsic characteristics, such as the precise genetic mutation, type of pathology, and tumor size [27, 28]; second, treatment with either chemotherapy or radiation therapy will affect the function of immune cells [29-31]; last, but not the least, the levels and functions of lymphocytes or monocytes can be regulated by tumor cells [32].…”

“…In this regard, the prognostic value of the lymphocyte to monocyte ratio (LMR), which mirrors the circulating immune status of the host, has been reported for a number of different malignancies [11-13]. In particular, LMR has been suggested as an effective prognostic factor for predicting clinical survival in DLBCL patients [14, 15]. However, a recent study has suggested that an immunological biomarker alone is not sufficient to predict survival and clinical responses, and the immune cell invigoration to tumor burden ratio could be useful as an indicator of clinical response [16].…”

Can the prognosis of mantle cell lymphoma be predicted by simple CBC counts?

“…[16] The prognostic value of LMR and platelet/lymphocyte ratio (PLR) has been investigated in 173 patients who were diagnosed with Primary Gastrointestinal Diffuse Large B-cell lymphoma (DLBCL), wherein NLR was described as an independent prognostic factor for survival; however, a relationship between PLR and the course of the disease was not observed. [17] On the other hand, absolute monocyte count (AMC) was demonstrated to be a reliable prognostic marker in DLBCL [18] and FL. [19] Von Hohenstaufen et al were the first to report that AMC could be used as an independent prognostic factor in MCL.…”