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.
BMC Cancer. 2019 Apr 11;19(1):338. doi: 10.1186/s12885-019-5552-1.
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.
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.
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.
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.
大多数成人霍奇金淋巴瘤（HL）患者的预后良好；他们中的大多数人可以达到永久性缓解，可以认为已经治愈。然而，许多人接受的标准现代治疗不足或过度。准确确定预后可以使临床医生根据疾病进展和生存的个体风险设计个性化治疗。诊断时的淋巴细胞-单核细胞比率（LMR）已被研究作为 HL 患者的预后生物标志物。我们的目的是通过研究 LMR 与生存结果之间的关系，探讨诊断时 LMR 在成人 HL 中的预后价值。
在 PUBMED 和 EMBASE 上搜索相关文章。我们研究的生存结果包括总生存率（OS）、无进展生存率（PFS）、无事件生存率（EFS）、淋巴瘤特异性生存率（LSS）和进展时间（TTP）。没有对语言、日期、研究国家或样本量进行限制。最后一次数据库搜索是在 2018 年 4 月 2 日进行的。如果有四项或更多关于特定结果的研究，我们将进行随机效应荟萃分析，以汇总和总结纳入研究的结果。
共选择了 8 项研究（均为回顾性队列研究），共纳入 3319 例 HL 患者进行分析。除了一项研究外，所有研究都报道了 LMR 对 OS 的影响；5 项研究报告了 PFS，3 项研究分别报告了 TTP 和 LSS，1 项研究报告了 EFS。汇总估计表明，低 LMR 与较差的 OS（风险比 [HR] 2.67，95%CI 1.67，4.26）和 PFS（HR 2.19，95%CI 1.46，3.29）相关。根据 LMR 截断值和样本量进行的 OS 亚组分析均表明，基线 LMR 较低与预后较差相关。
诊断时低 LMR 与 HL 的 OS 和 PFS 不良相关。LMR 易于确定且价格低廉，在日常临床管理中有潜在作用。需要更多的研究来验证这个生物标志物，并探索它与已知预后因素的相互作用。
