Watanabe Reina, Tomita Naoto, Itabashi Megumi, Ishibashi Daisuke, Yamamoto Eri, Koyama Satoshi, Miyashita Kazuho, Takahashi Hiroyuki, Nakajima Yuki, Hattori Yukako, Motohashi Kenji, Takasaki Hirotaka, Ohshima Rika, Hashimoto Chizuko, Yamazaki Etsuko, Fujimaki Katsumichi, Sakai Rika, Fujisawa Shin, Motomura Shigeki, Ishigatsubo Yoshiaki
Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan; Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Eur J Haematol. 2014 Mar;92(3):204-10. doi: 10.1111/ejh.12221. Epub 2013 Nov 28.
The tumor microenvironment, including tumor-infiltrating lymphocytes and myeloid-derived cells, is an important factor in the pathogenesis and clinical behavior of malignant lymphoma. However, the prognostic significance of peripheral lymphocytes and monocytes in lymphoma remains unclear.
We evaluated the prognostic impact of the absolute lymphocyte count (ALC), absolute monocyte count (AMC), and lymphocyte/monocyte ratio (LMR) in 359 diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP).
The median follow-up time of the surviving patients was 58 months. Low ALC and an elevated AMC were both associated with poor survival rates. Receiver operating characteristic curve analysis showed that LMR was the best predictor of survival, with 4.0 as the cutoff point. Patients with LMR ≤4.0 were more likely to have an aggressive tumor, and this was associated with poor treatment responses. Patients with LMR ≤4.0 at diagnosis had significantly poorer overall survival (OS) and progression-free survival (PFS) than those with LMR >4.0. Multivariate analysis, which included prognostic factors of the International Prognostic Index, showed LMR ≤4.0 to be an independent predictor for the OS (hazard ratio [HR], 2.507; 95% confidence interval [CI], 1.255-5.007; P = 0.009) and PFS (HR, 2.063; 95% CI, 1.249-3.408; P = 0.005).
The LMR at diagnosis, as a simple index which reflects host systemic immunity, predicts clinical outcomes in DLBCL patients treated with R-CHOP.
肿瘤微环境，包括肿瘤浸润淋巴细胞和髓系来源细胞，是恶性淋巴瘤发病机制和临床行为的重要因素。然而，淋巴瘤外周血淋巴细胞和单核细胞的预后意义仍不明确。
我们评估了359例接受利妥昔单抗联合环磷酰胺、阿霉素、长春新碱和泼尼松（R-CHOP）治疗的弥漫性大B细胞淋巴瘤（DLBCL）患者的绝对淋巴细胞计数（ALC）、绝对单核细胞计数（AMC）和淋巴细胞/单核细胞比值（LMR）对预后的影响。
存活患者的中位随访时间为58个月。低ALC和升高的AMC均与生存率低相关。受试者工作特征曲线分析表明，LMR是生存的最佳预测指标，临界值为4.0。LMR≤4.0的患者更易发生侵袭性肿瘤，且与治疗反应差相关。诊断时LMR≤4.0的患者总生存期（OS）和无进展生存期（PFS）明显低于LMR>4.0的患者。多因素分析纳入国际预后指数的预后因素，结果显示LMR≤4.0是OS（风险比[HR]，2.507；95%置信区间[CI]，1.255-5.007；P = 0.009）和PFS（HR，2.063；95%CI，1.249-3.408；P = 0.005）的独立预测指标。
诊断时的LMR作为反映宿主全身免疫的简单指标，可预测接受R-CHOP治疗的DLBCL患者的临床结局。
