A recent meta-analysis identified a strong correlation between an inflammation marker and survival outcomes for patients with diffuse large B-cell lymphoma, published in PLOS One (published online April 25, 2017; doi:10.1371/journal.pone.0176008).
Systemic inflammatory responses – which occurs during progression in the tumor microenvironment – has the potential to provide prognosis information for diffuse large B-cell lymphoma. One possible prognostic indicator, neutrophil-to-lymphocyte ratio, has been thoroughly investigated in patients with such disease. However, the results remain controversial, and more research is necessary to validate its value as a prognostic marker.
A group of Chinese researchers led by Jin Wang, MD, Hematology Department of Research Institute of Surgery, Daping Hospital (China), conducted a meta-analysis to evaluate neutrophil-to-lymphocyte ratio in diffuse large B-cell lymphoma as a potential predictor of overall survival (OS) and progression-free survival (PFS). Researchers pooled 9 relevant studies with 2297 patients with diffuse large B-cell lymphoma and compared their neutrophil-to-lymphocyte ratios to survival outcomes. Hazard ratios (HRs) and odds ratios (ORs) and their 95% confidence intervals (CIs) were used as effective measures in the analysis.
Results showed that neutrophil-to-lymphocyte ratio was a significant indicator for poor OS (HR, 1.84; 95% CI, 1.52-2.22; P < .001) and poor PFS (HR, 1.64; 95% CI, 1.36-1.98; P < .001). Neutrophil-to-lymphocyte ratio retained its strong predictor status for OS and PFS regardless of tumor location, sample size, or cut-off value.
Additionally, researchers investigated the association between neutrophil-to-lymphocyte ratio and clinicopathological features. Of the 8 features analyzed, Ann Arbor stage (OR, 2.09; 95% CI, 1.14-3.81; P = .017) lactate dehydrogenase level (OR, 2.74; 95% CI, 1.16-6.46; P = .021), extranodal disease (OR, 1.63; 95% CI, 1.06–2.52; P = .027), and International Prognostic Index score (OR, 2.44; 95% CI, 1.03–5.08; P = .043) were reported to have strong associations with neutrophil-to-lymphocyte ratio. No significant association was found with sex (OR, 0.89; 95% CI, 0.71–1.11; P = .29), age (OR, 1.18; 95% CI, 0.94–1.48; P = .152), European Cooperative Oncology Group performance status score (OR, 1.78; 95% CI, 0.71–4.46; P = .217), or presence of B symptoms (OR, 1.56; 95% CI, 0.7–3.48; P = .278).
Researchers concluded that the findings of the study reflect a strong association between neutrophil-to-lymphocyte ratio and poor OS and PFS in patients with diffuse large B-cell lymphoma. Neutrophil-to-lymphocyte ratio could be recommended as an inexpensive prognostic biomarker in such disease, they write. – Zachary Bessette
