Prognostic significance of pretreatment peripheral blood monocyte count in diffuse large B-cell lymphoma

doi:10.3760/cma.j.issn.1007-1245.2023.23.009

Abstract

Abstract:

Objective　To explore the prognostic value of pretreatment peripheral blood monocyte count in patients with diffuse large B cell lymphoma (DLBCL). Methods　A total of 641 newly diagnosed patients with DLBCL who were admitted to Fuzhou Second Hospital and Fujian Medical University Union Hospital from Jan 2016 to Dec 2021 were selected for the retrospective analysis, including 378 males and 263 females, aged 14-86 years. Receiver operating characteristic curve (ROC) analysis was performed to determine the optimal cut-off value of pretreatment peripheral blood monocyte count for prognosis in patients with DLBCL. The patients were divided into two groups, a high level group and a low level group, according to the cut-off value. The differences of clinical and laboratory characteristics, overall survival (OS), and progression-free survival (PFS) between the two groups were compared by χ² test and log-rank test, respectively. The relationships between these characteristics and prognosis were analyzed by univariate and multivariate regression analysis. Results　Compared with the low level group with pretreatment peripheral blood monocyte count, the proportions of patients with age >60 years old [44.70% (97/217) vs. 36.32% (154/424)], males [70.51% (153/217) vs. 53.07% (225/424)], lactate dehydrogenase (LDH) level above the upper limit of normal (ULN) [68.20% (148/217) vs. 40.80% (173/424)], high Eastern Cooperative Oncology Group (ECOG) score (2-4 points) [31.34% (68/217) vs. 16.27% (69/424)], Ann Arbor stage Ⅲ-Ⅳ [84.79% (184/217) vs. 58.73% (249/424)], site of extranodal lesions >1 [48.39% (105/217) vs. 30.42% (129/424)], B symptoms [31.34% (68/217) vs. 16.75% (71/424)], and high International Prognostic Index (IPI) score (3-5 points) [59.45% (129/217) vs. 32.08% (136/424)] and incidence of recurrence/refractory [34.56% (75/217) vs. 23.11% (98/424)] were higher in the high level group (all P<0.05). Univariate analysis showed that presence of B symptoms, LDH > ULN, high ECOG score (2-4 points), Ann Arbor stage Ⅲ-Ⅳ, site of extranodal lesions >1, non-germinal center B-cell (non-GCB) subtype, and high pretreatment peripheral blood monocyte count were associated with OS and PFS in the DLBCL patients (all P<0.05). Multivariate analysis showed that LDH > ULN, high ECOG score (2-4 points), and non-GCB subtype were independent poor prognostic factors for OS in the DLBCL patients (all P<0.05); high ECOG score (2-4 points), site of extranodal lesions >1, and non-GCB subtype were independent poor prognostic factors for PFS in the DLBCL patients (all P<0.05); high peripheral blood monocyte count was an independent poor prognostic factor for OS in the DLBCL patients (HR=1.80, 95%CI 1.14-2.82, P<0.01), but not an independent poor prognostic factor for PFS. Conclusion　High level of pretreatment peripheral blood monocyte count is an independent poor prognostic factor for OS in patients with DLBCL.

Key words:

Diffuse large B-cell lymphoma, Monocyte, Prognosis

摘要：

目的　探讨治疗前外周血单核细胞计数在弥漫大B细胞淋巴瘤（diffuse large B cell lymphoma，DLBCL）患者预后中的价值。方法　回顾性分析2016年1月至2021年12月初诊于福州市第二医院和福建医科大学附属协和医院的641例初治DLBCL患者为研究对象，其中男378例，女263例，年龄14～86岁。受试者工作特征曲线（ROC）确定治疗前外周血单核细胞计数最佳截断值；按截断值将患者分为外周血单核细胞计数高水平组（217例）和低水平组（424例）。χ²检验和log-rank检验分别比较两组患者临床和实验室特征、总生存期（OS）及疾病无进展生存期（PFS）的差异；单因素和多因素回归分析各指标与预后的关系。结果　与治疗前外周血单核细胞计数低水平组比较，高水平组患者年龄>60岁比例［44.70%（97/217）比36.32%（154/424）］、男性比例［70.51%（153/217）比53.07%（225/424）］、乳酸脱氢酶（LDH）水平高于正常上限（ULN）比例［68.20%（148/217）比40.80%（173/424）］、高美国东部肿瘤协作组（ECOG）评分（2～4分）比例［31.34%（68/217）比16.27%（69/424）］、Ann Arbor分期Ⅲ～Ⅳ比例［84.79%（184/217）比58.73%（249/424）］、结外病灶>1处比例［48.39%（105/217）比30.42%（129/424）］、有B症状比例［31.34%（68/217）比16.75%（71/424）］、高国际预后指数（IPI）评分（3～5分）比例［59.45%（129/217）比32.08%（136/424）］、复发/难治发生率［34.56%（75/217）比23.11%（98/424）］均更高（均P<0.05）。单因素分析显示，有B症状、LDH>ULN、高ECOG评分（2～4分）、Ann Arbor分期Ⅲ～Ⅳ、结外病灶>1处、非生发中心B细胞（non-GCB）亚型、外周血单核细胞计数高与DLBCL患者OS、PFS有关（均P<0.05）。多因素分析显示，LDH>ULN、高ECOG评分（2～4分）、non-GCB亚型是DLBCL患者OS的独立不良预后因子（均P<0.05）；高ECOG评分（2～4分）、结外病灶>1处、non-GCB亚型是DLBCL患者PFS的独立不良预后因子（均P<0.05）；外周血单核细胞计数高是DLBCL患者OS的独立不良预后因子（HR=1.80，95%CI 1.14～2.82，P<0.01），但不是DLBCL患者PFS的独立不良预后因子。结论　治疗前外周血单核细胞计数高是DLBCL患者OS的独立不良预后因子。

关键词:

弥漫大B细胞淋巴瘤, 单核细胞, 预后

Zhang Jinping, Fan Liping, Huang Zhenyu, Huang Xiaoling, Huang Haobo.

Prognostic significance of pretreatment peripheral blood monocyte count in diffuse large B-cell lymphoma [J]. International Medicine and Health Guidance News, 2023, 29(23): 3360-3365.

张进萍范丽萍黄震宇黄晓玲黄豪博.

治疗前外周血单核细胞计数在弥漫大B细胞淋巴瘤中的预后意义 [J]. 国际医药卫生导报, 2023, 29(23): 3360-3365.

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