Padwal Mahesh K, Nazar Amir K, Parghane Rahul V, Basu Sandip, Basu Bhakti
Molecular Biology Division, Bhabha Atomic Research Centre, Mumbai, India.
Homi Bhabha National Institute, Mumbai, India.
Endocrine. 2025 Mar 25. doi: 10.1007/s12020-025-04212-z.
This study aimed to investigate the role of pre-treatment neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) in the prognosis assessment of Lu-DOTATATE Peptide Receptor Radionuclide Therapy (PRRT) treated patients with advanced metastatic neuroendocrine tumors (NETs).
Eligible PRRT-treated patients (n = 247, 2010-2019) were included. Pre-PRRT NLR and MLR were calculated from complete blood count data. Data on tumor characteristics, response to PRRT, progression-free survival (PFS), and overall survival (OS) were evaluated using COXPH analyses.
In NET patients, median values of NLR and MLR were 2.21 (IQR = 1.66-3.00) and 0.14 (IQR = 0.06-0.24), respectively. NLR showed significant positive association with G3 tumors (median = 3.64, IQR = 2.1-4.26, p = 0.022) and high F-FDG avidity (SUVmax>5) (median = 2.5, IQR = 1.82-3.56, p = 0.003). MLR was significantly associated with high disease burden (median = 0.18, IQR = 0.08-0.29, p = 0.0083). MLR distinguished between the PRRT non-responders with progressive disease and responders with complete/partial response (median 0.19 versus 0.12, p = 0.043) or responders with stable disease (median 0.19 versus 0.14, p = 0.045). The ratios independently correlated with disease progression and OS. Patients in NLR (>3.5) group displayed significantly shorter median PFS and OS (48 and 58 months) compared to NLR (≤3.5) group (108 and 96 months) (p < 0.01). Patients in MLR (>0.25) group displayed significantly shorter median PFS and OS (40 and 52 months) compared to MLR (≤0.25) group (108 and 102 months) (p < 0.01).
Pre-treatment NLR and MLR had an independent prognostic impact on disease progression and OS in PRRT-treated NET patients. This routine, inexpensive CBC-based test in the standard pre-PRRT workup demonstrates the prognostic value and may aid clinicians in the risk stratification of NET patients.
本研究旨在探讨治疗前中性粒细胞与淋巴细胞比值（NLR）和单核细胞与淋巴细胞比值（MLR）在镥 - 奥曲肽肽受体放射性核素治疗（PRRT）的晚期转移性神经内分泌肿瘤（NETs）患者预后评估中的作用。
纳入符合条件的接受PRRT治疗的患者（n = 247，2010 - 2019年）。根据全血细胞计数数据计算PRRT治疗前的NLR和MLR。使用COXPH分析评估肿瘤特征、对PRRT的反应、无进展生存期（PFS）和总生存期（OS）的数据。
在NET患者中，NLR和MLR的中位数分别为2.21（四分位间距IQR = 1.66 - 3.00）和0.14（IQR = 0.06 - 0.24）。NLR与G3肿瘤（中位数 = 3.64，IQR = 2.1 - 4.26，p = 0.022）和高F - FDG摄取（SUVmax>5）（中位数 = 2.5，IQR = 1.82 - 3.56，p = 0.003）呈显著正相关。MLR与高疾病负担显著相关（中位数 = 0.18，IQR = 0.08 - 0.29，p = 0.0083）。MLR区分了疾病进展的PRRT无反应者和完全/部分反应的反应者（中位数0.19对0.12，p = 0.043）或疾病稳定的反应者（中位数0.19对0.14，p = 0.045）。这些比值与疾病进展和OS独立相关。与NLR（≤3.5）组（108和96个月）相比，NLR（>3.5）组患者的中位PFS和OS显著缩短（48和58个月）（p < 0.01）。与MLR（≤0.25）组（108和102个月）相比，MLR（>0.25）组患者的中位PFS和OS显著缩短（40和52个月）（p < 0.01）。
治疗前NLR和MLR对接受PRRT治疗的NET患者的疾病进展和OS具有独立的预后影响。在标准的PRRT治疗前检查中，这种基于全血细胞计数的常规且廉价的检测显示出预后价值，可能有助于临床医生对NET患者进行风险分层。
