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Ide D, Fujino T, Kobayashi T, Egashira A, Miyashita A, Mizuhara K, Isa R, Tsukamoto T, Mizutani S, Uchiyama H, Kaneko H, Uoshima N, Kawata E, Taniwaki M, Shimura Y, Kuroda J. Prognostic model for relapsed/refractory transplant-ineligible diffuse large B-cell lymphoma utilizing the lymphocyte-to-monocyte ratio. Int J Hematol 2024; 119:697-706. [PMID: 38492199 DOI: 10.1007/s12185-024-03750-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
We conducted a multi-institutional retrospective study in 100 transplant-ineligible (TI) patients with diffuse large B-cell lymphoma (DLBCL) that relapsed or progressed after first-line R-CHOP (or -like) therapy to develop a robust predictive model for TI relapsed/refractory (r/r) DLBCL, which has a heterogeneous but poor prognosis by currently available treatment modalities other than chimeric antigen receptor T-cell (CAR-T) therapy or bispecific antibodies. The median age at relapse or progression was 76 years. The median progression-free survival (PFS) and overall survival (OS) from the first progression were 11.5 months and 21.9 months, respectively. Multivariate analysis identified low lymphocyte-to-monocyte ratio (LMR), elevated high lactate dehydrogenase, and elevated C-reactive protein at progression as independent predictors of OS. A predictive model based on these three factors, here designated as the Kyoto Prognostic Index for r/r DLBCL (KPI-R), successfully stratified their OS and PFS with statistical significance. In addition, event-free survival less than 24 months for R-CHOP and low LMR were identified as significant predictive factors for non-response in any sequence of salvage therapy. We concluded that LMR is a bonafide predictor of treatment response and prognosis in patients with TI r/r DLBCL, and may be helpful in treatment decision-making.
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Affiliation(s)
- Daisuke Ide
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takahiro Fujino
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Tsutomu Kobayashi
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Aya Egashira
- Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Akihiro Miyashita
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kentaro Mizuhara
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Reiko Isa
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
- Department of Hematology, Aiseikai Yamashina Hospital, Kyoto, Japan
| | - Taku Tsukamoto
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinsuke Mizutani
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoji Uchiyama
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
- Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Hiroto Kaneko
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
- Department of Hematology, Aiseikai Yamashina Hospital, Kyoto, Japan
| | - Nobuhiko Uoshima
- Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Eri Kawata
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
- Department of Hematology, Matsushita Memorial Hospital, Moriguchi, Japan
| | - Masafumi Taniwaki
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Hematology, Aiseikai Yamashina Hospital, Kyoto, Japan
| | - Yuji Shimura
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Blood Transfusion, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Wu W, Zhao L, Wang Y, Chen P, Yuan X, Miao L, Zhu Y, Mao J, Cai Z, Ji Y, Wang L, Jia T. Prognostic value of the peripheral blood lymphocyte/monocyte ratio combined with 18F-FDG PET/CT in patients with diffuse large B-cell lymphoma. Curr Probl Cancer 2024; 48:101066. [PMID: 38364336 DOI: 10.1016/j.currproblcancer.2024.101066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/18/2023] [Accepted: 01/30/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE To explore the prognostic value of the peripheral blood lymphocyte/monocyte ratio (LMR) combined with 18F-FDG PET/CT for diffuse large B-cell lymphoma (DLBCL). METHODS The clinical data of 203 patients with primary DLBCL who were hospitalized to the First People's Hospital of Lianyungang between January 2017 and December 2022 were retrospectively analyzed. Before and after three courses of treatment, PET/CT was performed on forty DLBCL patients. The subject operating characteristic (ROC) curve has been employed to determine the most effective LMR cutoff points. According to the criteria for assessing the efficacy of Lugano lymphoma, the PET/CT findings after 3 courses of treatment were specified as complete remission (CR), partial remission (PR), stable disease (SD) and disease progression (PD). The CR group, PR+SD group, and PD group were the three groups created from the four outcomes. Results were analyzed using the Cox proportional risk model, the Kaplan-Meier method (K-M), and the log-rank test. RESULTS An optimal cutoff point of 3.00 for the LMR in 203 patients was determined by the SPSS 26 software ROC curve. When LMR≥3.00, the 1-year, 3-year, and 5-year OS (Overall Survival) rates are 98%, 88%, and 64% respectively, and the PFS (Progression-free Survival) rates are 90%, 75%, and 56% respectively. When LMR <3.00, the 1-year, 3-year, and 5-year OS rates are 96%, 72%, and 28% respectively, and the PFS rates are 83%, 60%, and 28% respectively. A lower LMR was substantially related with shorter OS, and PFS, according to a K-M survival analysis (P<0.005). LMR<3.00 was an independent predictor of OS, based on a multifactorial Cox analysis (P=0.037). K-M survival analysis of the 18F-FDG PET/CT results of 40 patients revealed that both OS and PFS were statistically significant (P<0.001). Patients were separated into 3 groups combining LMR and 18F-FDG PET/CT: PET/CT CR patients with LMR≥3.00, PET/CT PD patients with LMR<3.00, and others. The Kaplan-Meier analysis revealed that there were significant differences in OS and PFS for each of the three groups (P<0.001). ROC curves showed that the area under the curve (AUC) of the combined testing of the two was 0.735, and the combined testing of the two was better compared to testing alone (PET/CT AUC=0.535, LMR AUC=0.567). This indicates that combining both PET/CT and LMR is a favorable prediction for DLBCL. CONCLUSION A decreased LMR at initial diagnosis suggests an unfavorable prognosis for DLBCL patients; For patients with DLBCL, combining 18F-FDG PET/CT and the LMR has a better predictive value.
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Affiliation(s)
- Wenke Wu
- Jinzhou Medical University, Jinzhou, Liaoning 121001, China; Department of Hematology, Postgraduate Training Base of the Lian Yungang First People's Hospital of Jinzhou Medical University, Lianyungang, Jiangsu 222000, China
| | - Lidong Zhao
- Department of Hematology, The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu 222000, China
| | - Ying Wang
- Department of Hematology, The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu 222000, China
| | - Peng Chen
- Department of Nuclear Medicine, The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu 222000, China
| | - Xiaoshuai Yuan
- Department of Nuclear Medicine, The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu 222000, China
| | - Lei Miao
- Department of Hematology, The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu 222000, China
| | - Yuanxin Zhu
- Department of Hematology, The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu 222000, China
| | - Jianping Mao
- Department of Hematology, The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu 222000, China
| | - Zhimei Cai
- Department of Hematology, The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu 222000, China
| | - Yajun Ji
- Department of Oncology, The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu 222000, China
| | - Lei Wang
- Department of Oncology, The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu 222000, China
| | - Tao Jia
- Department of Hematology, The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu 222000, China.
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Li C, Zhang W, Zhao D, Yang P, Wan W, Liu S, Jing H. Development of a new risk scoring system based on spleen involvement and the lymphocyte/monocyte ratio for follicular lymphoma patients. Leuk Res 2022; 123:106980. [DOI: 10.1016/j.leukres.2022.106980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/15/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022]
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Clinical and biological prognostic factors in follicular lymphoma patients. PLoS One 2022; 17:e0272787. [PMID: 35925993 PMCID: PMC9351995 DOI: 10.1371/journal.pone.0272787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Follicular lymphoma (FL) is an indolent, yet heterogeneous, B-cell lymphoproliferative disorder. Although most FL patients respond well to treatment, few with specific traits have a poor prognosis; the latter are difficult to define.
Patients and methods
We retrospectively analyzed data from 143 FL patients treated at the University of Debrecen since 2009 and investigated prognostic factors that may influence the survival of FL patients.
Results
A maximum standardized uptake value (SUVmax) cut-off of 9.85 at the staging positron emission tomography/computed tomography (PET/CT) (p = 0.0001, hazard ratio [HR]: 0.2535, 95% confidence interval [CI]: 0.1118–0.4878) and a lymphocyte/monocyte (Ly/Mo) ratio of 3.41 (p = 0.0027, HR: 2.997, 95% CI: 1.463–6.142), drawn at diagnosis, significantly predicted FL patients’ progression-free survival (PFS). A staging SUVmax >9.85 with Ly/Mo <3.41 could delineate a high-risk group of FL patients (p<0.0001, HR: 0.0957, 95% CI: 0.03416–0.2685). Similarly, a significant difference was shown with an SUVmax cut-off of 3.15 at the interim PET/CT (p<0.0001, HR: 0.1614, 95% CI: 0.06684–0.3897). A staging SUVmax >9.85 in conjunction with interim SUVmax >3.15 predicted poor prognosis (p<0.0001, HR: 0.1037, 95% CI: 0.03811–0.2824). The PFS difference was translated into overall survival (OS) advantage (p = 0.0506, HR: 0.1187, 95% CI: 0.01401–1.005).
Conclusion
Biological prognostic factors, such as the Ly/Mo ratio, may improve the prognostic assessment of staging PET/CT. The survival advantage observed in PFS is translated into OS when determined using a combination of staging and interim SUVmax. We recommend investigating additional biological prognostic factors while highlighting the role of PET/CT in FL.
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Vajavaara H, Leivonen S, Jørgensen J, Holte H, Leppä S. Low lymphocyte-to-monocyte ratio predicts poor outcome in high-risk aggressive large B-cell lymphoma. EJHAEM 2022; 3:681-687. [PMID: 36051040 PMCID: PMC9421995 DOI: 10.1002/jha2.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/12/2022]
Abstract
Low lymphocyte-to-monocyte-ratio (LMR) has been associated with unfavorable survival in patients with diffuse large B-cell lymphoma (DLBCL). To date, however, the impact of LMR on survival has not been examined in a uniformly treated cohort of patients with high-risk aggressive large B-cell lymphoma. We collected peripheral blood absolute lymphocyte counts (ALCs) and absolute monocyte counts (AMC) prior to treatment and calculated LMR from 112 adult patients, who were less than 65 years of age, had age-adjusted International Prognostic Index 2-3, or site-specific risk factors for central nervous system (CNS) recurrence, and were treated in a Nordic Lymphoma Group LBC-05 trial with dose-dense immunochemotherapy and early systemic CNS prophylaxis (www.ClinicalTrials.gov, number NCT01325194). Median pretreatment ALC was 1.40 × 109/l (range, 0.20-4.95), AMC 0.68 × 109/l (range, 0.10-2.62), and LMR 2.08 (range, 0.10-12.00). ALC did not correlate with tumor-infiltrating lymphocytes, AMC did not correlate with tumor-associated macrophages, and neither ALC nor AMC correlated with survival. However, low LMR (<1.72) translated to unfavourable progression-free survival (PFS) (5-year PFS 70% vs. 92%, p = 0.002) and overall survival (OS) (5-year OS, 77% vs. 92%, p = 0.020). In the patients with low LMR, relative risk of progression was 4.4-fold (95% confidence interval [CI] 1.60-12.14, p = 0.004), and relative risk of death was 3.3-fold (95% CI 1.18-9.50, p = 0.024) in comparison to the patients with high LMR. We conclude that low LMR is an adverse prognostic factor in uniformly treated young patients with high-risk aggressive large B-cell lymphoma.
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Affiliation(s)
- Heli Vajavaara
- Research Program UnitApplied Tumor GenomicsFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of OncologyHelsinki University Hospital Comprehensive Cancer CenterHelsinkiFinland
- iCAN Digital Precision Cancer Medicine FlagshipHelsinkiFinland
| | - Suvi‐Katri Leivonen
- Research Program UnitApplied Tumor GenomicsFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of OncologyHelsinki University Hospital Comprehensive Cancer CenterHelsinkiFinland
- iCAN Digital Precision Cancer Medicine FlagshipHelsinkiFinland
| | - Judit Jørgensen
- Department of HematologyAarhus University HospitalAarhusDenmark
| | - Harald Holte
- Department of OncologyKG Jebsen Center for B‐Cell MalignanciesOslo University HospitalOsloNorway
| | - Sirpa Leppä
- Research Program UnitApplied Tumor GenomicsFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of OncologyHelsinki University Hospital Comprehensive Cancer CenterHelsinkiFinland
- iCAN Digital Precision Cancer Medicine FlagshipHelsinkiFinland
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Wu J, Wang X, Zhou M, Chen GB, Du J, Wang Y, Ye C. The value of lymphocyte-to-monocyte ratio and neutrophil-to-lymphocyte ratio in differentiating pneumonia from upper respiratory tract infection (URTI) in children: a cross-sectional study. BMC Pediatr 2021; 21:545. [PMID: 34861849 PMCID: PMC8641150 DOI: 10.1186/s12887-021-03018-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/17/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUNDS Early and accurate diagnosis of pediatric pneumonia in primary health care can reduce the chance of long-term respiratory diseases, related hospitalizations and mortality while lowering medical costs. The aim of this study was to assess the value of blood biomarkers, clinical symptoms and their combination in assisting discrimination of pneumonia from upper respiratory tract infection (URTI) in children. METHODS Both univariate and multivariate logistic regressions were used to build the pneumonia screening model based on a retrospective cohort, comprised of 5211 children (age ≤ 18 years). The electronic health records of the patients, who had inpatient admission or outpatient visits between February 15, 2012 to September 30, 2018, were extracted from the hospital information system of Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China. The children who were diagnosed with pneumonia and URTI were enrolled and their clinical features and levels of blood biomarkers were compared. Using the area under the ROC curve, both two screening models were evaluated under 80% (training) versus 20% (test) cross-validation data split for their accuracy. RESULTS In the retrospective cohort, 2548 of 5211 children were diagnosed with the defined pneumonia. The univariate screening model reached predicted AUCs of 0.76 for lymphocyte/monocyte ratio (LMR) and 0.71 for neutrophil/lymphocyte ratio (NLR) when identified overall pneumonia from URTI, attaining the best performance among the biomarker candidates. In subgroup analysis, LMR and NLR attained AUCs of 0.80 and 0.86 to differentiate viral pneumonia from URTI, and AUCs of 0.77 and 0.71 to discriminate bacterial pneumonia from URTI respectively. After integrating LMR and NLR with three clinical symptoms of fever, cough and rhinorrhea, the multivariate screening model obtained increased predictive values, reaching validated AUCs of 0.84, 0.95 and 0.86 for distinguishing pneumonia, viral pneumonia and bacterial pneumonia from URTI respectively. CONCLUSIONS Our study demonstrated that combining LMR and NLR with critical clinical characteristics reached promising accuracy in differentiating pneumonia from URTI, thus could be considered as a useful screening tool to assist the diagnosis of pneumonia, in particular, in community healthcare centers. Further researches could be conducted to evaluate the model's clinical utility and cost-effectiveness in primary care scenarios to facilitate pneumonia diagnosis, especially in rural settings.
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Affiliation(s)
- Jinghua Wu
- Department of health management, Hangzhou Normal University, Zhejiang, 310000, Hangzhou, China.,Engineering Research Center of Mobile Health Management System, Ministry of Education, Hangzhou Normal University, Zhejiang, 310000, Hangzhou, China
| | - Xu Wang
- Department of Laboratory Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, 310014, Hangzhou, China.,School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Mingqi Zhou
- Department of health management, Hangzhou Normal University, Zhejiang, 310000, Hangzhou, China.,Engineering Research Center of Mobile Health Management System, Ministry of Education, Hangzhou Normal University, Zhejiang, 310000, Hangzhou, China
| | - Guo-Bo Chen
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Zhejiang, 310000, Hangzhou, China.,Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang, 310000, Hangzhou, China
| | - Jing Du
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang, 310000, Hangzhou, China
| | - Ying Wang
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang, 310000, Hangzhou, China.
| | - Chengyin Ye
- Department of health management, Hangzhou Normal University, Zhejiang, 310000, Hangzhou, China. .,Engineering Research Center of Mobile Health Management System, Ministry of Education, Hangzhou Normal University, Zhejiang, 310000, Hangzhou, China.
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Sorigue M, Sancho JM. The lymphocyte-to-monocyte ratio in follicular lymphoma. Leuk Lymphoma 2021; 62:2558-2561. [PMID: 34100677 DOI: 10.1080/10428194.2021.1929965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Marc Sorigue
- Department of Hematology, ICO-Hospital Germans Trias i Pujol. IJC. Universitat Autònoma de Barcelona, Badalona, Spain
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Hospital Germans Trias i Pujol. IJC. Universitat Autònoma de Barcelona, Badalona, Spain
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Is Neutrophils / Lymphocytes Ratio Affected During 'Migraine Attacks with Aura' in Migraine Patients? JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2021. [DOI: 10.30621/jbachs.883583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Xu P, Sun X, Song X, Peng Y, He B, Wu Z, Zhu J. Prognostic value of lymphocyte-to-monocyte ratio and histone methyltransferase G9a histone methyltransferase in patients with double expression lymphoma: A retrospective observational study. Medicine (Baltimore) 2021; 100:e24449. [PMID: 33530253 PMCID: PMC7850655 DOI: 10.1097/md.0000000000024449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/19/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT In patients with diffuse large B-cell lymphoma, MYC combined with Bcl2 and/or Bcl6-based protein expression is called double expression lymphoma (DEL). R-DA-EPOCH program chemotherapy is typically recommended because these patients often have a poor prognosis. Although numerous factors affect survival of patients with DEL, the roles of the tumor biomarker histone methyltransferase G9a (G9a) and the lymphocyte-to-monocyte ratio (LMR) are unknown.We performed a retrospective analysis of data from 51 patients. These patients were newly diagnosed with DEL and treated with R-DA-EPOCH at Taizhou People' s Hospital and Northern Jiangsu People's Hospital between June 2014 and December 2019. Receiver operator characteristic curve results were used to calculate the LMR cutoff value. We used an immunohistochemical analysis to examine G9a expression in DEL tissues. The Kaplan-Meier method was used to determine progression-free survival (PFS) and overall survival (OS) characteristics. Cox proportional-hazards models were constructed for univariate and multivariate analyses to examine the prognostic values of LMRs and G9a in patients with DEL.The cutoff value for LMR was 2.18. The 5-year PFS rate was 35.3%, and the 5-year OS rate was 39.2%. Patients with DEL with lower LMRs and who were G9a-positive predicted inferior PFS and OS. Univariate analysis revealed that patients with elevated LDH levels, high National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) scores, LMRs ≤2.18, and G9a-positive results had relatively poorer PFS and OS. The multivariate analysis revealed that LMRs ≤2.18 and a G9a-positive result were independent prognostic factors for PFS and OS in patients with DEL treated with R-DA-EPOCH.The study results suggested that peripheral blood LMRs were an important marker for evaluation of prognosis in patients with DEL. High expression of G9a was associated with worse outcomes, indicating that G9a may serve as a prognostic biomarker for patients with DEL who undergo R-DA-EPOCH program chemotherapy.
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Affiliation(s)
- Pei Xu
- Department of Hematology, the People's Hospital of Taizhou, Taizhou
| | - Xiaolin Sun
- Institute of Translational Medicine, Medical College, Yangzhou University
| | - Xuyan Song
- Department of Hematology, the People's Hospital of Taizhou, Taizhou
| | - Yaqian Peng
- Department of Hematology, the People's Hospital of Taizhou, Taizhou
| | - Bin He
- Department of Hematology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Zhengdong Wu
- Department of Hematology, the People's Hospital of Taizhou, Taizhou
| | - Jianfeng Zhu
- Department of Hematology, the People's Hospital of Taizhou, Taizhou
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Mozas P, Rivero A, Rivas-Delgado A, Nadeu F, Clot G, Correa JG, Castillo C, Bataller A, Baumann T, Giné E, Delgado J, Villamor N, Campo E, Pérez-Galán P, Magnano L, López-Guillermo A. A low lymphocyte-to-monocyte ratio is an independent predictor of poorer survival and higher risk of histological transformation in follicular lymphoma. Leuk Lymphoma 2020; 62:104-111. [PMID: 32954916 DOI: 10.1080/10428194.2020.1821010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The lymphocyte-to-monocyte ratio (LMR) is a prognostic factor in different neoplasms, but its potential importance in follicular lymphoma (FL) is not well defined. We studied 384 FL patients for which the LMR was available at diagnosis. Baseline features and outcomes were compared between patients with an LMR ≤/>2.5. The 76 patients (20%) who had an LMR ≤2.5 were older and had a higher tumor burden. A low LMR was predictive of a lower 10-y progression-free survival (32 vs. 55%, p = .001) and overall survival (35 vs. 78%, p < .0001; HR = 2.3, p = .003 in a 6-element multivariable model). A low LMR was also an independent risk factor for histological transformation (11 vs. 6% at 10 years, p = .01). Likewise, patients with a low LMR had a higher rate of second malignancies. The potential utility of this widely available parameter and its contribution to well-established prognostic scores need to be explored in independent, prospective series.
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Affiliation(s)
- Pablo Mozas
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Andrea Rivero
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Ferran Nadeu
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Guillem Clot
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Carlos Castillo
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alex Bataller
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Tycho Baumann
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eva Giné
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Julio Delgado
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Neus Villamor
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Hematopathology Unit, Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Elías Campo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Hematopathology Unit, Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - Patricia Pérez-Galán
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Laura Magnano
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Armando López-Guillermo
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Universitat de Barcelona, Barcelona, Spain
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11
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Stefaniuk P, Szymczyk A, Podhorecka M. The Neutrophil to Lymphocyte and Lymphocyte to Monocyte Ratios as New Prognostic Factors in Hematological Malignancies - A Narrative Review. Cancer Manag Res 2020; 12:2961-2977. [PMID: 32425606 PMCID: PMC7196794 DOI: 10.2147/cmar.s245928] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/11/2020] [Indexed: 12/11/2022] Open
Abstract
Despite the presence of many hematological prognostic indexes, clinical course and overall survival are often highly variable even within the same patient subgroup. Recent studies suggest that simple, cost-effective, low-risk tests such as neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ratio (LMR) may be used to evaluate the prognosis. Their role has been well confirmed in diffuse large B-cell lymphoma (DLBCL), Hodgkin lymphoma (HL) and multiple myeloma (MM), but until now the prognostic significance of NLR and LMR in leukemias has not been widely reported. In this article, we analyze the literature data on prognostic value of NLR and LMR in haematological malignancies in the context of classic prognostic factors and clinical course.
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Affiliation(s)
- Paulina Stefaniuk
- Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Szymczyk
- Department of Clinical Transplantology, Medical University of Lublin, Lublin, Poland
| | - Monika Podhorecka
- Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
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12
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Mohsen A, Taalab M, Abousamra N, Mabed M. Prognostic Significance of Absolute Lymphocyte Count, Absolute Monocyte Count, and Absolute Lymphocyte Count to Absolute Monocyte Count Ratio in Follicular Non-Hodgkin Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e606-e615. [PMID: 32303487 DOI: 10.1016/j.clml.2020.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Recently, the lymphocyte to monocyte ratio (LMR) has been proposed as an easily determinable prognostic factor in patients with cancer, including lymphomas. The objective of this study was the evaluation of the impact of baseline absolute lymphocyte count (ALC), absolute monocyte count (AMC), and the LMR on the treatment response and prognosis in follicular lymphoma (FL). PATIENTS AND METHODS The data of 100 patients with a FL variant, admitted and treated between January 2009 and June 2018, were analyzed. RESULTS The area under the receiver operator characteristic curve and cutoff values of ALC, AMC, and LMR for discrimination between survival times using receiver operating characteristic curves showed 0.57 × 109/L as the most discriminative ALC cutoff value, 1.235 ×109/L as the most discriminative AMC cutoff value, and 1.63 as the most discriminative LMR cutoff value. Progressive disease and stable disease after first-line therapy and mortality rate were significantly associated with lower ALC, higher AMC, and higher LMR. Shorter overall survival (OS) was significantly associated with patients with lower ALC when compared with those having higher ALC. Shorter OS and progression-free survival (PFS) were significantly associated with higher AMC when compared with those having lower AMC. Shorter OS and PFS were significantly associated with lower LMR when compared with those having higher LMR. High-risk Follicular Lymphoma International Prognostic Index as well as low LMR were considered as risk factors for prediction of OS in all the studied patients with FL in univariate analysis and multivariate analysis. CONCLUSION ALC, AMC, and LMR at diagnosis are simple indices, which reflect the host systemic immunity and can predict the clinical outcomes in FL.
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Affiliation(s)
- Asmaa Mohsen
- Clinical Hematology Unit, Internal Medicine Department, Faculty of Medicine, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Mona Taalab
- Clinical Hematology Unit, Internal Medicine Department, Faculty of Medicine, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Nashawa Abousamra
- Clinical Pathology Department, Hematology Unit, Faculty of Medicine, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed Mabed
- Clinical Hematology Unit, Internal Medicine Department, Faculty of Medicine, Oncology Center, Mansoura University, Mansoura, Egypt.
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13
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Yazar HO, Yazar T, Aygün A, Kaygisiz Ş, Kirbaş D. Evaluation of simple inflammatory blood parameters in patients with migraine. Ir J Med Sci 2019; 189:677-683. [PMID: 31758522 DOI: 10.1007/s11845-019-02136-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/09/2019] [Indexed: 02/06/2023]
Abstract
AIM This study aimed to identify the serum neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), and C-reactive protein (CRP)/albumin (CAR) ratios among patients with diagnosis of migraine according to migraine subtypes (attack/attack-free period, migraine with or without aura, episodic/chronic migraine, family history/no family history) and to collect data to investigate the role of inflammation and oxidative stress in etiology. METHOD The study was completed with 235 patients with migraine diagnosis classified according to the International Classification of Headache Disorders-2013(ICHD) classification and 166 healthy controls. Patients with migraine were assessed during the attack by emergency medicine specialists in the emergency room and in attack-free periods in neurology clinics by neurology specialists. RESULTS Of patients with migraine, 77.02% were female and 22.98% were male. The neutrophil, NLR, PLR, and MLR levels were higher than the control group (p < 0.05). The serum CRP, neutrophil, NLR, MLR, and CAR levels were higher, and albumin and lymphocyte levels were lower during migraine attack periods (p < 0.05). Migraines with aura were observed to have higher serum NLR levels compared to the aura-free patients (p < 0.05). Migraine patients with positive family history were found to have higher NLR levels compared to patients without a family history (p < 0.05). CONCLUSION Although non-specific, serum NLR, MLR, PLR, and CAR levels may be potential biomarkers associated with migraine subtypes with different clinical features such as migraine attack period, migraine with aura, and patients with family history of migraine. Elevated inflammatory markers may indicate the severity of disease.
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Affiliation(s)
- Hülya Olgun Yazar
- Ordu University Education and Research Hospital, Bucak Mh. Ordu Üniversitesi Eğitim Araştırma Hastanesi, Pk:52200 Merkez, Ordu, Turkey.
| | | | - Ali Aygün
- Department of Emergency Medicine, Faculty of Medicine, Ordu University Ordu, Ordu, Turkey
| | - Şükran Kaygisiz
- Ordu University Education and Research Hospital, Bucak Mh. Ordu Üniversitesi Eğitim Araştırma Hastanesi, Pk:52200 Merkez, Ordu, Turkey
| | - Dursun Kirbaş
- İstanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital, İstanbul, Turkey
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14
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Shimono J, Takahashi S, Takemura R, Kakinoki Y. Useful prognostic tools based on complete blood cell counts in diffuse large B-cell lymphoma. Int J Lab Hematol 2019; 41:754-761. [PMID: 31529774 DOI: 10.1111/ijlh.13106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/12/2019] [Accepted: 08/22/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Diffuse large B-cell lymphoma (DLBCL) is the most frequent lymphoma. Three prognostic factors are widely used in DLBCL: International Prognostic Index (IPI), Revised-IPI (R-IPI), and National Comprehensive Cancer Network-IPI (NCCN-IPI). METHOD We established a prognostic model using peripheral blood absolute lymphocyte/absolute monocyte counts ratio (LMR), hemoglobin, and platelet counts obtained from complete blood cell counts (CBC) data at diagnosis based on 214 cases of DLBCL who received more than one course of R-CHOP therapy at a single institution. RESULTS The cutoff values for using the receiver operating characteristics (ROC) curve for LMR, hemoglobin, and platelet counts were 1.6, 100 g/L, and 150 × 109 /L, respectively. Stratification was performed using the three factors (LMR < 1.6, hemoglobin < 100 g/L, and platelet counts < 150 × 109 /L). CBC Group 1 (none of the 3 factors) included 92 cases, CBC Group 2 (1 or 2 of these factors) included 108 cases, and CBC Group 3 (all 3 factors) included 11 cases. The 5-year OS rates were 78.2%, 60.9%, and 10.1%, respectively. In multivariate analysis, CBC Group 3 (hazard ratio, 2.9760; 95% confidence interval, 1.2670-6.991; P = .01) were prognostic factors for OS. CBC Group 3 had factors based on which the further stratification of the poor prognosis group into IPI high-risk and R-IPI poor-risk groups (P = .01, <.0001, respectively) was possible. CONCLUSIONS In DLBCL, combination of three CBC parameters has the potential to be a useful prognostic tool.
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Affiliation(s)
- Joji Shimono
- Department of Hematology, Asahikawa city hospital, Asahikawa, Japan.,Department of Hematology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shogo Takahashi
- Department of Hematology, Asahikawa city hospital, Asahikawa, Japan
| | - Ryo Takemura
- Department of Hematology, Asahikawa city hospital, Asahikawa, Japan
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15
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Wang L, Sheng JJ, Zhao H, Su L, Liu CY, Wan SG. [The prognostic significance of lymphocyte/monocyte ratio in diffuse large B cell lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:436-438. [PMID: 31207713 PMCID: PMC7342244 DOI: 10.3760/cma.j.issn.0253-2727.2019.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- L Wang
- Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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16
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Lee SF, Ng TY, Spika D. Prognostic value of lymphocyte-monocyte ratio at diagnosis in Hodgkin lymphoma: a meta-analysis. BMC Cancer 2019; 19:338. [PMID: 30971203 PMCID: PMC6458704 DOI: 10.1186/s12885-019-5552-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 03/28/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prognoses of most adult Hodgkin lymphoma (HL) patients are excellent; most of them can achieve permanent remission that can be considered cured. However, many are under-treated or over-treated by standard modern therapies. An accurate determination of prognosis may allow clinicians to design personalised treatment according to individual risk of disease progression and survival. Lymphocyte monocyte ratio (LMR) at diagnosis has been investigated as a prognostic biomarker in patients with HL. Our objective with this meta-analysis was to explore the prognostic value of the LMR at diagnosis in adult HL, by investigating the association between LMR and survival outcomes. METHODS PUBMED and EMBASE were searched for relevant articles. Survival outcomes that we investigated included overall survival (OS), progression-free survival (PFS), event-free survival (EFS), lymphoma-specific survival (LSS), and time to progression (TTP). No restriction to the language, date, study country, or sample size was applied. Final search of databases was performed on 2 April 2018. We performed random-effects meta-analysis to aggregate and summarise the results from included studies, where four or more studies on a particular outcome were available. RESULTS A total of eight studies (all retrospective cohort studies) involving 3319 HL patients were selected for analysis. All studies except one reported the effect of LMR on OS; five reported on PFS, three reported on TTP and LSS, respectively, and one reported on EFS. The pooled estimates showed low LMR was associated with poor OS (hazard ratio [HR] 2.67, 95% CI 1.67, 4.26) and PFS (HR 2.19, 95% CI 1.46, 3.29). Subgroup analyses of OS stratified by LMR cut-off values and sample sizes both indicated that low baseline LMR was associated with poorer prognosis. CONCLUSIONS Low LMR at diagnosis was associated with poor OS and PFS in HL. LMR is easy and cheap to determine and has a potential role in daily clinical management. More studies are needed to validate this biomarker and explore its interaction with known prognostic factors.
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territory West Cluster, Hospital Authority, Tuen Mun, Hong Kong
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ting Ying Ng
- Department of Clinical Oncology, Tuen Mun Hospital, New Territory West Cluster, Hospital Authority, Tuen Mun, Hong Kong
| | - Devon Spika
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Lund, Sweden
- Department of Economics, School of Economics and Management, Lund University, Lund, Sweden
- London School of Hygiene and Tropical Medicine, London, UK
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17
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Amini RM, Enblad G, Hollander P, Laszlo S, Eriksson E, Ayoola Gustafsson K, Loskog A, Thörn I. Altered profile of immune regulatory cells in the peripheral blood of lymphoma patients. BMC Cancer 2019; 19:316. [PMID: 30953461 PMCID: PMC6449984 DOI: 10.1186/s12885-019-5529-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 03/27/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Regulatory immune cells may modulate the lymphoma microenvironment and are of great interest due to the increasing prevalence of treatment with immunotherapies in lymphoma patients. The aim was to explore the composition of different immune regulatory cell subsets in the peripheral blood of newly diagnosed lymphoma patients in relation to treatment outcome. METHODS Forty-three newly diagnosed patients with lymphoma were included in the study; 24 with high-grade B-cell lymphoma (HGBCL) and 19 with classical Hodgkin lymphoma (cHL). Peripheral blood was prospectively collected and immune regulatory cells were identified by multi-color flow cytometry and analyzed in relation to healthy blood donors and clinical characteristics and outcome. RESULTS The percentage of CD3-positive T-cells was lower (p = 0.03) in the peripheral blood of lymphoma patients at diagnosis compared to healthy blood donors regardless of lymphoma subtype, although statistically, neither the percentage of monocytes (p = 0.2) nor the T-cell/monocyte ratio (p = 0.055) differed significantly. A significant decrease in the percentage of a subset of regulatory NK cells (CD7+/CD3-/CD56bright/CD16dim/-) was identified in the peripheral blood of lymphoma patients compared to healthy blood donors (p = 0.003). Lymphoma patients also had more granulocytic myeloid-derived suppressor cells (MDSCs) (p = 0.003) compared to healthy blood donors, whereas monocytic MDSCs did not differ significantly (p = 0.07). A superior disease-free survival was observed for cHL patients who had an increase in the percentage of granulocytic MDSCs (p = 0.04). CONCLUSIONS An altered profile of immune cells in the peripheral blood with a decrease in T-cells and regulatory NK-cells was observed in newly diagnosed lymphoma patients. CHL patients with higher percentages of regulatory NK cells and higher percentages of granulocytic MDSCs might have a better outcome, although the number of patients was low.
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Affiliation(s)
- R-M Amini
- Clinical and Experimental Pathology, Department of Immunology, Genetics and Pathology, Uppsala University and Uppsala University Hospital, Rudbeck Laboratory, C5, SE-75185, Uppsala, Sweden.
| | - G Enblad
- Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - P Hollander
- Clinical and Experimental Pathology, Department of Immunology, Genetics and Pathology, Uppsala University and Uppsala University Hospital, Rudbeck Laboratory, C5, SE-75185, Uppsala, Sweden
| | - S Laszlo
- Clinical and Experimental Pathology, Department of Immunology, Genetics and Pathology, Uppsala University and Uppsala University Hospital, Rudbeck Laboratory, C5, SE-75185, Uppsala, Sweden
| | - E Eriksson
- Clinical Immunology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - K Ayoola Gustafsson
- Medical Genetics and Genomics, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - A Loskog
- Clinical Immunology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Lokon Pharma, AB, Uppsala, Sweden
| | - I Thörn
- Clinical and Experimental Pathology, Department of Immunology, Genetics and Pathology, Uppsala University and Uppsala University Hospital, Rudbeck Laboratory, C5, SE-75185, Uppsala, Sweden
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18
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Lee SF, Luque-Fernandez MA. Prognostic value of lymphocyte-to-monocyte ratio and neutrophil-to-lymphocyte ratio in follicular lymphoma: a retrospective cohort study. BMJ Open 2017; 7:e017904. [PMID: 29101140 PMCID: PMC5695484 DOI: 10.1136/bmjopen-2017-017904] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The 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. DESIGN A retrospective cohort study. SETTING Regional cancer centre in Hong Kong. PARTICIPANTS 88 patients with histologically proven FL diagnosed between 2000 and 2014. MATERIALS AND METHODS The 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. RESULTS The 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). CONCLUSIONS Baseline 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.
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Miguel Angel Luque-Fernandez
- Department of Non-Communicable Disease Epidemiology, Cancer Survival Group, London School of Hygiene & Tropical Medicine, London, UK
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Zhou S, Xu L, Ma Y, Tang L, Zhang Y, Shi Y, Sun L, Chen Y, Liang B, Zhou Y, Yu K, Shen J. Peripheral blood lymphocyte to monocyte ratio recovery from low levels at diagnosis after completion of first line therapy predicts good clinical outcomes in patients with diffuse large B-cell lymphoma. Oncotarget 2017; 8:19556-19565. [PMID: 28107187 PMCID: PMC5386705 DOI: 10.18632/oncotarget.14700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 12/27/2016] [Indexed: 12/31/2022] Open
Abstract
We retrospectively analyzed LMR at diagnosis and at completion of first-line therapy and prognosis in173 patients with DLBCL from 2005 to 2016. We found that patients with an LMR < 3.2 at diagnosis, as well as at completion of first-line therapy, had significantly lower PFS and OS rates than those with an LMR ≥ 3.2 (P<0.05). Patients with LMR that recovered from the low level at diagnosis showed superior overall survival (OS) (P=0.000) and progression-free survival (PFS) (P=0.001) compared with patients who failed to achieve a higher value at the completion of therapy. The multivariate analysis demonstrated that LMR values that did not increase upon completion of first-line therapy were an independent predictor for inferior OS (P=0.021) and PFS (P=0.046). In conclusion, LMR at diagnosis and at completion of first-line therapy is a simple biomarker to predict clinical outcomes in DLBCL. LMR recovery from low levels at diagnosis, irrespective of whether LMR reached the cutoff value, was associated with improved clinical outcomes.
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Affiliation(s)
- Shujuan Zhou
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Linglong Xu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Yongyong Ma
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Liyuan Tang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yu Zhang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yifen Shi
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Lan Sun
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yi Chen
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Bin Liang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yuhong Zhou
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Kang Yu
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Jianping Shen
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
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C-reactive protein-to-albumin ratio is a predictor of hepatitis B virus related decompensated cirrhosis: time-dependent receiver operating characteristics and decision curve analysis. Eur J Gastroenterol Hepatol 2017; 29:472-480. [PMID: 27984322 DOI: 10.1097/meg.0000000000000807] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Hepatitis B virus (HBV) infection remains a major health problem and HBV-related-decompensated cirrhosis (HBV-DC) usually leads to a poor prognosis. Our aim was to determine the utility of inflammatory biomarkers in predicting mortality of HBV-DC. MATERIALS AND METHODS A total of 329 HBV-DC patients were enrolled. Survival estimates for the entire study population were generated using the Kaplan-Meier method. The prognostic values for model for end-stage liver disease (MELD) score, Child-Pugh score, and inflammatory biomarkers neutrophil/lymphocyte ratio, C-reactive protein-to-albumin ratio (CAR), and lymphocyte-to-monocyte ratio (LMR) for HBV-DC were compared using time-dependent receiver operating characteristic curves and time-dependent decision curves. RESULTS The survival time was 23.1±15.8 months. Multivariate analysis identified age, CAR, LMR, and platelet count as prognostic independent risk factors. Kaplan-Meier analysis indicated that CAR of at least 1.0 (hazard ratio, 7.19; 95% confidence interval, 4.69-11.03), and LMR less than 1.9 (hazard ratio, 2.40; 95% confidence interval, 1.69-3.41) were independently associated with mortality of HBV-DC. The time-dependent receiver operating characteristic indicated that CAR showed the best performance in predicting mortality of HBV-DC compared with LMR, MELD score, and Child-Pugh score. The results were also confirmed by time-dependent decision curves. CONCLUSION CAR and LMR were associated with the prognosis of HBV-DC. CAR was superior to LMR, MELD score, and Child-Pugh score in HBV-DC mortality prediction.
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Lymphocyte-monocyte ratio at admission predicts possible outcomes in patients with acute-on-chronic liver failure. Eur J Gastroenterol Hepatol 2017; 29:31-35. [PMID: 27779494 DOI: 10.1097/meg.0000000000000767] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The lymphocyte-monocyte ratio (LMR) in the peripheral blood is suggested to be a potential biomarker for predicting the clinical outcomes of several diseases. We aimed to evaluate the relative efficiency of LMR for predicting 3-month mortality in patients with acute-on-chronic liver failure (AoCLF). PATIENTS AND METHODS In this study, 74 chronic hepatitis B patients, 90 AoCLF patients, and 70 healthy controls were followed up for 4 months. The primary endpoint was 3-month in-hospital mortality. Hematological and virological parameters as well as liver biochemistry were determined using blood samples ordered upon admission. A panel of clinical and biochemical variables were analyzed for potential associations with outcomes using Cox proportional hazards and multiple regression models. RESULTS A significantly lower LMR was detected in AoCLF patients than in healthy controls and chronic hepatitis B groups (both P=0.001). The LMR inversely correlated with model for end-stage liver disease scores, and a lower LMR was associated with increased 3-month mortality. Multivariate analysis suggested that both LMR and model for end-stage liver disease scores were independent predictors of 3-month mortality (P<0.01). CONCLUSION A low LMR measured at admission is predictive of a poor prognosis in AoCLF patients.
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Peripheral blood lymphocyte/monocyte ratio following completion of first-line therapy predicts early relapse in patients with diffuse large B cell lymphoma. Ann Hematol 2016; 96:237-243. [DOI: 10.1007/s00277-016-2865-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/20/2016] [Indexed: 01/25/2023]
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FCG (FLIPI, Charlson comorbidity index, and histological grade) score is superior to FLIPI in advanced follicular lymphoma. Int J Hematol 2016; 104:692-699. [PMID: 27714586 DOI: 10.1007/s12185-016-2099-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 02/07/2023]
Abstract
The Follicular Lymphoma International Prognostic Index (FLIPI) is widely used in the identification of risk groups among follicular lymphoma (FL) patients. The aim of the present study was to evaluate the prognostic value of FLIPI combined with the Charlson comorbidity index (CCI) and histological grade of lymphoma. 224 newly diagnosed FL patients (median age 56 years) treated with immunochemotherapy were retrospectively analysed. Low FLIPI had 21.0 % of patients, intermediate 28.1 % and high 46.9 %. 50.9 % of patients had no comorbidities. Only 7.1 % of patients had a high CCI score (≥2), while 25.9 % of patients were histological grade 3. Parameters that influenced overall survival were evaluated using Cox regression analysis, in which CCI, FLIPI and histological grade (p < 0.05) retained prognostic significance. By combining these parameters, we have developed the FCG score, which incorporates FLIPI, CCI, and histological grade. This score defines three risk categories (low: 41.5 %; intermediate: 37.5 %; high: 13.4 %), associated with significantly different survival (p < 0.0001); this consequently improves discriminative power by 9.1 % compared to FLIPI. FCG score represents a possible new prognostic index, highlighting the role of the patient's clinical state and the histological characteristics of disease, as indicated by comorbidity index and histological grade of lymphoma.
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Zhang XY, Xu J, Zhu HY, Wang Y, Wang L, Fan L, Wu YJ, Li JY, Xu W. Negative prognostic impact of low absolute CD4 + T cell counts in peripheral blood in mantle cell lymphoma. Cancer Sci 2016; 107:1471-1476. [PMID: 27465799 PMCID: PMC5084668 DOI: 10.1111/cas.13020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/15/2016] [Accepted: 07/25/2016] [Indexed: 02/06/2023] Open
Abstract
Tumor microenvironment and host immunity are closely related to outcome in patients with mantle cell lymphoma (MCL). However, few researchers have focused on the prognostic value of peripheral blood lymphocyte subsets counts. The purpose of this study was to investigate the prognostic value of lymphocyte subsets and absolute monocyte counts. Sixty-eight patients were analyzed retrospectively. Absolute CD4+ T cell counts (ACD4C), CD8+ T cell counts, nature killer cell counts, and CD4/CD8 ratios were assessed by peripheral blood flow cytometry and correlated with clinical parameters and long-term outcomes. The median follow-up for all patients was 21 months and the median survival time was 44 months. The overall survival (OS) rate at 1, 3, and 5 years was 80%, 51%, and 41%, respectively. In our cohort, high absolute monocyte count, and low ACD4C and CD4/CD8 ratio were associated with unfavorable OS (P = 0.029, P = 0.027, and P = 0.045, respectively) by univariate analysis. Multivariate analysis indicated that low ACD4C was a significant predictor of unfavorable OS (P = 0.004) independent of the simplified MCL International Prognostic Index (P = 0.048) in patients treated with or without rituximab (P = 0.011). Low CD4+ T cell counts proved to be a significant predictor of unfavorable OS in patients with MCL.
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Affiliation(s)
- Xin-Yu Zhang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Ji Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Hua-Yuan Zhu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Yan Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Li Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Lei Fan
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Yu-Jie Wu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Jian-Yong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China. .,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China.
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Wang J, Zhou M, Xu JY, Yang YG, Zhang QG, Zhou RF, Chen B, Ouyang J. Prognostic role of pretreatment neutrophil-lymphocyte ratio in patients with diffuse large B-cell lymphoma treated with RCHOP. Medicine (Baltimore) 2016; 95:e4893. [PMID: 27661033 PMCID: PMC5044903 DOI: 10.1097/md.0000000000004893] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This study aims to investigate whether neutrophil to lymphocyte ratio (NLR) is an independent predictor in newly diagnosed diffuse large B-cell lymphoma (DLBCL) patients in the rituximab era. Data from newly diagnosed DLBCL patients at Nanjing Drum Tower Hospital from 2006 to 2015 were retrospectively reviewed. We used the receiver operating characteristic (ROC) curve analysis to generate the optimal cutoff value for NLR. Among those 156 patients enrolled, the NLR was < 3.0 in 46.8% (73/156) of the patients, and the remaining 53.2% (83/156) had an NLR ≥ 3.0. Patients with higher pretreatment NLR were found to correlate with poorer OS and PFS than these with lower NLR (hazard ratio [HR] = 2.66, 95% confidence interval [CI] = 1.43-4.97, P = 0.002 and HR = 1.79, 95% CI = 1.05-3.07, P = 0.034, respectively). The multivariate Cox proportional hazard model analysis further showed that high NLR was found independently predictive of poor OS (HR = 0.40; CI = 0.19-0.84, P = 0.015) and PFS (HR = 0.57; CI = 0.33-0.98, P = 0.042). Consequently, pretreatment NLR was an independent prognostic predictor in patients with DLBCL in the rituximab era.
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Affiliation(s)
| | | | | | | | | | | | - Bing Chen
- Department of Hematology, the Affiliated DrumTower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, PR China
- Correspondence: Bing Chen, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, Jiangsu China (e-mail: )
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Low absolute CD4 + T cell counts in peripheral blood are associated with inferior survival in follicular lymphoma. Tumour Biol 2016; 37:12589-12595. [PMID: 27388165 DOI: 10.1007/s13277-016-5124-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 06/09/2016] [Indexed: 12/16/2022] Open
Abstract
Host immunity and tumor microenvironment significantly influence follicular lymphoma (FL) outcomes. Lymphopenia has been identified as a negative prognostic factor for FL. However, there is limited data regarding prognostic value of peripheral blood T lymphocyte subsets, especially absolute CD4+ T cell counts (ACD4C) in FL. We studied 127 consecutive FL patients to investigate whether peripheral blood ACD4C or absolute monocytes (AMC) at diagnosis had an impact on FL prognosis. In our cohort, both low ACD4C and high AMC were the parameters associated with inferior progression-free survival (PFS) (P = 0.021 and P = 0.013, respectively) and inferior overall survival (OS) (P = 0.020 and P = 0.005, respectively) by univariate analysis. Multivariate analysis revealed that only low ACD4C was statistically significant in worse PFS (hazard ratio, 2.811; 95 % confidence interval, 1.137-6.950; P = 0.025) and shorter OS (hazard ratio, 3.393; 95 % confidence interval, 1.037-11.105; P = 0.043) independent of FLIPI-2. Evaluation of blood ACD4C could be a useful indicator of outcome in previously untreated FL patients.
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Li SW, Yuan W, Zhao B, He ZK, Guo X, Xia WX, Xu LH. Positive effect of HPV status on prognostic value of blood lymphocyte-to-monocyte ratio in advanced cervical carcinoma. Cancer Cell Int 2016; 16:54. [PMID: 27382361 PMCID: PMC4932757 DOI: 10.1186/s12935-016-0334-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 06/26/2016] [Indexed: 01/12/2023] Open
Abstract
Background This retrospective study aimed to investigate the prognostic significance of pretreatment lymphocyte-to-monocyte ratio (LMR) in locally advanced cervical cancer and its effect on overall survival. Methods The usual blood routine test was quantitatively performed to detect LMR. Signal strengths of human papilloma virus (HPV) type DNA in detected cervical cancer samples using hybrid capture 2 were analyzed in relative light units (RLU) compared with 1 pg/mL of HPV type 16 DNA-positive control (RLU/PC) samples. A total of 1.0 RLU/PC (~1 pg/mL) was used as the threshold for a positive result. The HPV-positive specimens were typed using reverse-hybridization line probe assay. Results The LMR and HPV DNA were found to be independent prognostic markers for 5-year overall survival (OS) and progression-free survival, respectively. Their joint detection may further enhance the predictive value for OS. In the positive HR (high risk)-HPV DNA status subgroup, LMR had a positive effect on improved OS but not in the non-HR HPV DNA status subgroup. Conclusions The LMR and HR-HPV DNA status can be identified as independent prognostic factors. The different influences of LMR in combined chemoradiotherapy on survival may be related to HR-HPV DNA status. The combined detection of LMR and HR-HPV DNA status may contribute to screening prognosis.
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Affiliation(s)
- Si-Wei Li
- Department of Radiation Oncology, the Affiliated Hospital of Guilin Medical University, Guilin, 541004 People's Republic of China
| | - Wenxin Yuan
- Department of Ultrasonography, the First Affiliated Hospital, Nanchang University, Nanchang, People's Republic of China
| | - Bo Zhao
- Department of Radiation Oncology, the Affiliated Hospital of Guilin Medical University, Guilin, 541004 People's Republic of China
| | - Zhuo-Kai He
- Department of Radiation Oncology, the Affiliated Hospital of Guilin Medical University, Guilin, 541004 People's Republic of China
| | - Xiang Guo
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in Southern China, Guangzhou, 510060 People's Republic of China
| | - Wei-Xiong Xia
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in Southern China, Guangzhou, 510060 People's Republic of China
| | - Li-Hua Xu
- Department of Hematology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230 People's Republic of China.,Guangdong Key Laboratory of Urology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong People's Republic of China
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Gu L, Li H, Chen L, Ma X, Li X, Gao Y, Zhang Y, Xie Y, Zhang X. Prognostic role of lymphocyte to monocyte ratio for patients with cancer: evidence from a systematic review and meta-analysis. Oncotarget 2016; 7:31926-42. [PMID: 26942464 PMCID: PMC5077986 DOI: 10.18632/oncotarget.7876] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 02/10/2016] [Indexed: 12/22/2022] Open
Abstract
Inflammation influences cancer development and progression, and a low lymphocyte to monocyte ratio (LMR) has been reported to be a poor prognostic indicator in several malignancies. Here we quantify the prognostic impact of this biomarker and assess its consistency in various cancers. Eligible studies were retrieved from PubMed, Embase and Web of Science databases. Overall survival (OS) was the primary outcome, cancer-specific survival (CSS), disease-free survival (DFS), recurrence-free survival (RFS), and progression-free survival (PFS) were secondary outcomes. Pooled hazard ratios (HRs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Fifty-six studies comprising 20,248 patients were included in the analysis. Overall, decreased LMR was significantly associated with shorter OS in non-hematological malignancy (HR: 0.59, 95% CI: 0.53-0.66; P < 0.001) and hematological malignancy (HR: 0.44, 95% CI: 0.34-0.56; P < 0.001). Similar results were found in CSS, DFS, RFS and PFS. Moreover, low LMR was significantly associated with some clinicopathological characteristics that are indicative of poor prognosis and disease aggressiveness. By these results, we conclude that a decreased LMR implied poor prognosis in patients with cancer and could serve as a readily available and inexpensive biomarker for clinical decision.
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Affiliation(s)
- Liangyou Gu
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Hongzhao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Luyao Chen
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xin Ma
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xintao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Yu Gao
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Yu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Yongpeng Xie
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Xu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
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Sun HL, Pan YQ, He BS, Nie ZL, Lin K, Peng HX, Cho WC, Wang SK. Prognostic performance of lymphocyte-to-monocyte ratio in diffuse large B-cell lymphoma: an updated meta-analysis of eleven reports. Onco Targets Ther 2016; 9:3017-23. [PMID: 27284252 PMCID: PMC4881929 DOI: 10.2147/ott.s96910] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose The findings on the prognostic value of lymphocyte-to-monocyte ratio (LMR) in diffuse large B-cell lymphoma (DLBCL) are inconsistent. This meta-analysis was conducted to more precisely evaluate the prognostic significance of LMR in DLBCL. Methods This analysis combined eleven studies with 4,578 patients aiming to assess the association of LMR with overall survival (OS) and progression-free survival (PFS) in DLBCL. Data from studies directly reporting a hazard ratio (HR) with 95% corresponding confidence interval (CI) in multivariate analysis were pooled to estimate the effect. Results Our results suggested that patients with decreased LMR had shorter OS (HR =1.79, 95% CI =1.54–2.08, P<0.001) and PFS (HR =2.21, 95% CI =1.80–2.72, P<0.001) in DLBCL. Stratified analyses indicated that each confounder showed consistent prognostic value in DLBCL. There was no significant heterogeneity for PFS (PH=0.192) and OS (PH=0.212) among the enrolled studies. Conclusion This meta-analysis indicated that decreased LMR might be a marker in the prediction of poor prognosis for patients with DLBCL.
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Affiliation(s)
- Hui-Ling Sun
- Central Laboratory, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Yu-Qin Pan
- Central Laboratory, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Bang-Shun He
- Central Laboratory, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Zhen-Lin Nie
- Laboratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Kang Lin
- Central Laboratory, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Hong-Xin Peng
- Central Laboratory, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China; Medical College, Southeast University, Nanjing, People's Republic of China
| | - William C Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, People's Republic of China
| | - Shu-Kui Wang
- Central Laboratory, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
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Xia WK, Lin QF, Shen D, Liu ZL, Su J, Mao WD. Prognostic significance of lymphocyte-to-monocyte ratio in diffuse large B-cell lymphoma: a systematic review and meta-analysis. FEBS Open Bio 2016; 6:558-65. [PMID: 27419058 PMCID: PMC4887971 DOI: 10.1002/2211-5463.12066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 03/05/2016] [Accepted: 03/31/2016] [Indexed: 12/20/2022] Open
Abstract
Published evidence on the prognostic significance of lymphocyte-to-monocyte ratio (LMR) in diffuse large B-cell lymphoma (DLBCL) is controversial. We performed an updated meta-analysis from 12 reports with 5021 patients to more accurately evaluate the prognostic value of LMR in DLBCL. Herein, we confirmed that patients with low LMR had shorter overall survival and progression-free survival than those with high LMR in DLBCL. Subgroup analyses indicated that patient source, cut-off values of LMR, treatment methods, and sample size showed similar prognostic performance in DLBCL patients. No significant heterogeneity was observed for progression-free survival (PFS, P (het) = 0.192) among the enrolled studies. The meta-analysis suggests that the LMR may be a potential biomarker in the prediction of clinical outcomes for DLBCL patients.
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Affiliation(s)
- Wen-Kai Xia
- Department of Nephrology The Affiliated Jiangyin Hospital of Southeast University Medical College Jiangsu China
| | - Qing-Feng Lin
- Department of Oncology The Affiliated Jiangyin Hospital of Southeast University Medical College Jiangsu China
| | - Dong Shen
- Department of Oncology The Affiliated Jiangyin Hospital of Southeast University Medical College Jiangsu China
| | - Zhi-Li Liu
- Department of Oncology The Affiliated Jiangyin Hospital of Southeast University Medical College Jiangsu China
| | - Jun Su
- Department of Oncology The Affiliated Jiangyin Hospital of Southeast University Medical College Jiangsu China
| | - Wei-Dong Mao
- Department of Oncology The Affiliated Jiangyin Hospital of Southeast University Medical College Jiangsu China
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Vassilakopoulos TP, Dimopoulou MN, Angelopoulou MK, Petevi K, Pangalis GA, Moschogiannis M, Dimou M, Boutsikas G, Kanellopoulos A, Gainaru G, Plata E, Flevari P, Koutsi K, Papageorgiou L, Telonis V, Tsaftaridis P, Sachanas S, Yiakoumis X, Tsirkinidis P, Viniou NA, Siakantaris MP, Variami E, Kyrtsonis MC, Meletis J, Panayiotidis P, Konstantopoulos K. Prognostic Implication of the Absolute Lymphocyte to Absolute Monocyte Count Ratio in Patients With Classical Hodgkin Lymphoma Treated With Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine or Equivalent Regimens. Oncologist 2016; 21:343-53. [PMID: 26921291 DOI: 10.1634/theoncologist.2015-0251] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/24/2015] [Indexed: 01/02/2023] Open
Abstract
Low absolute lymphocyte count (ALC) to absolute monocyte count (AMC) ratio (ALC/AMC) is an independent prognostic factor in Hodgkin lymphoma (HL), but different cutoffs (1.1, 1.5, and 2.9) have been applied. We aimed to validate the prognostic significance of ALC/AMC in 537 homogenously treated (doxorubicin, bleomycin, vinblastine, and dacarbazine or equivalents ± radiotherapy) classical HL patients at various cutoffs. The median ALC/AMC was 2.24 (0.44-20.50). The median AMC was 0.653 × 10(9)/L (0.050-2.070). Lower ALC/AMC was associated with established markers of adverse prognosis. In total, 477 (89%), 418 (78%), and 189 (35%) patients had an ALC/AMC ratio of ≥1.1, ≥1.5, and ≥2.9; respectively; 20% had monocytosis (≥0.9 × 10(9)/L). Ten-year time to progression (TTP) was 77% versus 55% for patients with ALC/AMC ≥1.1 and <1.1 (p = .0002), 76% versus 68% for ALC/AMC ≥1.5 and <1.5 (p = .049), 77% versus 73% for ALC/AMC ≥2.9 and <2.9 (p = .35), and 79% versus 70% for ALC/AMC ≥2.24 and <2.24 (p = .08), respectively. In stages ΙΑ/ΙΙΑ and in patients ≥60 years old, ALC/AMC had no significant effect on TTP. In advanced stages, ALC/AMC was significant only at the cutoff of 1.1 (10-year TTP 67% vs. 48%; p = .016). In younger, advanced-stage patients, the differences were more pronounced. In multivariate analysis of TTP, ALC/AMC < 1.1 (p = .007) and stage IV (p < .001) were independent prognostic factors; ALC/AMC was independent of International Prognostic Score in another model. ALC/AMC was more predictive of overall survival than TTP. At the cutoff of 1.1, ALC/AMC had independent prognostic value in multivariate analysis. However, the prognostically inferior group comprised only 11% of patients. Further research is needed prior to the widespread use of this promising marker.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria N Dimopoulou
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria K Angelopoulou
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriaki Petevi
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Maria Dimou
- First Propedeutic Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Boutsikas
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Kanellopoulos
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabriella Gainaru
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Plata
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Pagona Flevari
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Koutsi
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Loula Papageorgiou
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilios Telonis
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis Tsaftaridis
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Nora-Athina Viniou
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina P Siakantaris
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Variami
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marie-Christine Kyrtsonis
- First Propedeutic Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Meletis
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis Panayiotidis
- First Propedeutic Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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The Role of Lymphocyte to Monocyte Ratio, Microvessel Density and HiGH CD44 Tumor Cell Expression in Non Hodgkin Lymphomas. Pathol Oncol Res 2016; 22:567-77. [PMID: 26750138 DOI: 10.1007/s12253-015-0032-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 12/14/2015] [Indexed: 12/22/2022]
Abstract
Prognostic significance of immune microenvironment has been emphasized using the most advanced analysis, with consecutive attempts to reveal prognostic impact of this findings. The aim of this study was to compare and define prognostic significance of clinical parameters, microvessel density (MVD) in tumour tissue and expression of CD44s as adhesive molecule on tumour cells in diffuse large B cell lymphoma-DLBCL, primary central nervous system DLBCL-CNS DLBCL and follicular lymphoma-FL. A total of 202 histopathological samples (115 DLBCL/65 FL/22 CNS DLBCL) were evaluated. Overall response (complete/partial remission) was achieved in 81.3 % DLBCL patients, 81.8 % primary CNS DLBCL and 92.3 % FL. Absolute lymphocyte count-ALC/Absolute monocyte count-AMC >2.6 in DLBCL and ALC/AMC ≥ 4.7 in FL were associated with better event-free survival (EFS) and overall survival (OS) (p < 0.05). In DLBCL, MVD > 42 blood vessels/0.36 mm(2) correlated with primary resistant disease (p < 0.0001), poorer EFS and OS (p = 0.014). High CD44s expression in FL correlated with inferior EFS and OS (p < 0.01). In DLBCL, multivariate Cox regression analysis showed that ALC/AMC was independent parameter that affected OS (HR 3.27, 95 % CI 1.51-7.09, p = 0.003) along with the NCCN-IPI (HR 1.39, 95 % CI 1.08-1.79, p = 0.01). Furthermore, in FL, ALC/AMC mostly influenced OS (HR 5.21, 95 % CI 1.17-23.21, p = 0.03), followed with the FLIPI (HR 3.98, 95 % CI 1.06-14.95, p = 0.041). In DLBCL and FL, ALC/AMC is simple and robust tool that is, with current prognostic scores, able to define long-term survival and identify patients with inferior outcome. The introduction of immunochemotherapy might altered the prognostic significance of microenvionmental biomarkers (MVD and CD44s).
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Zhang J, Feng G, Zhao Y, Zhang J, Feng L, Yang J. Association between lymphocyte-to-monocyte ratio (LMR) and the mortality of HBV-related liver cirrhosis: a retrospective cohort study. BMJ Open 2015; 5:e008033. [PMID: 26297362 PMCID: PMC4550728 DOI: 10.1136/bmjopen-2015-008033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/24/2015] [Accepted: 07/30/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Infection with hepatitis B virus (HBV) remains a major cause of liver cirrhosis (LC) in China. Recent reports suggest that the lymphocyte-to-monocyte ratio (LMR) is a potential biomarker for predicting clinical outcomes. In our study, we investigated if LMR can be used as a prognostic marker of mortality in patients with HBV-related LC. DESIGN A retrospective cohort study. SETTING HBV-infected patients with LC and patients with chronic hepatitis B infection (CHB) from the Department of Infectious Disease were enrolled and 240 healthy individuals were recruited from the healthcare centre at the First Affiliated Hospital of Zhejiang University. PARTICIPANTS 479 HBV-infected patients with LC, 134 patients with CHB and 240 healthy individuals were enrolled. PRIMARY AND SECONDARY OUTCOME MEASURES The receiver operating characteristic (ROC) curve and multivariable logistic regression analysis after adjusting for total protein, albumin, total bilirubin and the model for end-stage liver disease (MELD) score were used to evaluate the power of LMR for predicting 1 year mortality in patients with LC. RESULTS The LMR was statistically lower in patients with LC. The MELD score and mortality were statistically higher in patients with LC compared with the CHB and control groups. The area under the ROC curve, cut-off values, sensitivity and specificity of LMR for predicting mortality LC in the training cohort were 0.817 (95% CI 0.746 to 0.888; p<0.001), 2.10, 82.6 and 78.8%, and these data were confirmed in the validation cohort. The multivariate logistic regression analysis showed that LMR was an independent predictive factor of mortality in LC (OR 2.370, 95% CI (1.070 to 5.249); p=0.033). CONCLUSIONS Our results strongly suggest that low LMR can be considered as an independent biomarker for predicting mortality in patients with LC.
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Affiliation(s)
- Jie Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Guofang Feng
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Zhao
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Juanwen Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Limin Feng
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jing Yang
- Department of Clinical Laboratory, The Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
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