Department of Oncology for Child and Adolescents, University Paris-Saclay, Gustave Roussy, Villejuif, France.
Biostatistics Unit, Gustave Roussy, Villejuif, France.
Pediatr Blood Cancer. 2024 Jul;71(7):e31029. doi: 10.1002/pbc.31029. Epub 2024 Apr 28.
Previous studies have shown that neutrophil-to-lymphocyte (NLR) ratio at diagnosis and early lymphocytes recovery on doxorubicin-based chemotherapy, may impact the outcome in patients with osteosarcoma (OST). This study aimed to evaluate the prognostic value of hemogram parameters in patients with OST treated with high-dose methotrexate and etoposide/ifosfamide (M-EI) chemotherapy.
We retrospectively analyzed the prognostic value of various hemogram parameters at diagnosis and during therapy in a large consecutive cohort of patients with OST included in the French OS2006 trial and treated with M-EI chemotherapy.
A total of 164 patients were analyzed. The median age was 14.7 years (interquartile range [IQR]: 11.7-17). Median follow-up was 5.6 years (IQR: 3.3-7.7 years). Three-year event-free survival (EFS) and overall survival (OS) were 71.5% (95% confidence interval [CI]: 64%-78%) and 86.4% (95% CI: 80%-91%), respectively. In univariate analysis, blood count parameters at diagnosis and early lymphocyte recovery at Day 14 were not found prognostic of survival outcomes. By contrast, an increase of NLR ratio at Day 1 of the first EI chemotherapy (NLR-W4) was associated with reduced OS in univariate (p = .0044) and multivariate analysis (hazards ratio [HR] = 1.3, 95% CI: 1.1-1.5; p = .002), although not with EFS. After adjustment on histological response and metastatic status, an increase of the ratio NLR-W4 of 1 was associated with an increased risk of death of 30%.
We identified NLR-W4 as a potential early biomarker for survival in patients with OST treated with M-EI chemotherapy. Further studies are required to confirm the prognostic value of NLR and better identify immune mechanisms involved in disease surveillance.
先前的研究表明，在基于多柔比星的化疗中，诊断时的中性粒细胞与淋巴细胞（NLR）比值和早期淋巴细胞恢复情况可能会影响骨肉瘤（OST）患者的预后。本研究旨在评估在接受大剂量甲氨蝶呤和依托泊苷/异环磷酰胺（M-EI）化疗的 OST 患者中，血液参数的预后价值。
我们回顾性分析了纳入法国 OS2006 试验并接受 M-EI 化疗的 OST 大连续队列患者的诊断时和治疗期间各种血液参数的预后价值。
共分析了 164 例患者。中位年龄为 14.7 岁（四分位距[IQR]：11.7-17）。中位随访时间为 5.6 年（IQR：3.3-7.7 年）。3 年无事件生存（EFS）和总生存（OS）分别为 71.5%（95%可信区间[CI]：64%-78%）和 86.4%（95% CI：80%-91%）。单因素分析中，诊断时的血液计数参数和第 14 天的早期淋巴细胞恢复情况与生存结果无关。相比之下，在第 1 天的首次 EI 化疗（NLR-W4）中的 NLR 比值增加与单因素（p=0.0044）和多因素分析（危险比[HR]=1.3，95% CI：1.1-1.5；p=0.002）中的 OS 降低相关，但与 EFS 无关。在调整组织学反应和转移性状态后，NLR-W4 比值增加 1 与死亡风险增加 30%相关。
我们发现 NLR-W4 可作为接受 M-EI 化疗的 OST 患者生存的潜在早期生物标志物。需要进一步的研究来证实 NLR 的预后价值，并更好地识别参与疾病监测的免疫机制。
