完整血球计数评分模型整合了降低的淋巴细胞单核细胞比值、升高的中性粒细胞淋巴细胞比值和升高的血小板淋巴细胞比值，可预测成人 T 淋巴细胞白血病不良的临床结局。
Complete Blood Count Score Model Integrating Reduced Lymphocyte-Monocyte Ratio, Elevated Neutrophil-Lymphocyte Ratio, and Elevated Platelet-Lymphocyte Ratio Predicts Inferior Clinical Outcomes in Adult T-Lymphoblastic Lymphoma.
机构信息
Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
出版信息
Oncologist. 2019 Nov;24(11):e1123-e1131. doi: 10.1634/theoncologist.2018-0789. Epub 2019 Apr 5.
BACKGROUND
T-lymphoblastic lymphoma (T-LBL) is a highly aggressive neoplasm of lymphoblasts of T-cell origin. Although promising improvements have been recently achieved, one third of patients experience relapse or refractory T-LBL. Therefore, optimal strategies for identifying high-risk patients are urgently needed.
MATERIALS AND METHODS
In the present study, 75 newly diagnosed adult patients (aged ≥15 years) with T-LBL were identified and the predictive value of complete blood count (CBC) abnormalities, including lymphocyte-monocyte ratio (LMR), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) on clinical outcomes, was analyzed.
RESULTS
Using the receiver operating characteristic curve to determine the best cutoff values based on survival, it was found that patients with T-LBL with LMR ≤2.8, NLR ≥3.3, and PLR ≥200 had both inferior progression-free survival (PFS) and inferior overall survival (OS), in which the differences were much more remarkable in the international prognostic index score 0-2 subgroup. In the multivariable analysis, NLR ≥3.3 together with age >40 years and central nervous system (CNS) involvement were identified to be independently associated with shortened PFS, whereas PLR ≥200 and CNS involvement were identified to be independent risk factors for OS. LMR, NLR, and PLR were integrated to generate a "CBC score" model, which well separated adult patients with T-LBL into three risk groups, and the 3-year OS was 84%, 53%, and 30% for low-, intermediate-, and high-risk patients, respectively.
CONCLUSION
Overall, a "CBC score" model was initially promoted for stratification in adult patients with T-LBL using simple, widely available, and easy to interpret parameters in the largest adult T-LBL cohort to date.
IMPLICATIONS FOR PRACTICE
Optimal strategies for identifying high-risk patients with T-lymphoblastic lymphoma (T-LBL) are urgently needed. In the largest adult T-LBL cohort to date, simple, inexpensive, widely available parameters were applied and revealed that patients with lymphocyte-monocyte ratio (LMR) ≤2.8, neutrophil-lymphocyte ratio (NLR) ≥3.3, and platelet-lymphocyte ratio (PLR) ≥200 had both inferior progression-free survival and inferior overall survival (OS), in which the differences were much more remarkable in the international prognostic index score 0-2 subgroup. LMR, NLR, and PLR were integrated to generate a "complete blood count score" model, in which the 3-year OS was 84%, 53%, and 30% for low-, intermediate-, and high-risk patients, respectively.
背景
T 淋巴母细胞淋巴瘤（T-LBL）是一种来源于 T 细胞的淋巴母细胞来源的高度侵袭性肿瘤。尽管最近取得了有希望的改善，但仍有三分之一的患者出现 T-LBL 复发或难治。因此，迫切需要确定高危患者的最佳策略。
材料和方法
本研究共纳入 75 例新诊断的成人 T-LBL 患者（年龄≥15 岁），分析了全血细胞计数（CBC）异常，包括淋巴细胞-单核细胞比值（LMR）、中性粒细胞-淋巴细胞比值（NLR）和血小板-淋巴细胞比值（PLR）对临床结局的预测价值。
结果
使用基于生存的受试者工作特征曲线确定最佳截断值，发现 LMR≤2.8、NLR≥3.3 和 PLR≥200 的 T-LBL 患者的无进展生存期（PFS）和总生存期（OS）均较差，在国际预后指数评分 0-2 亚组中差异更为显著。在多变量分析中，NLR≥3.3 以及年龄>40 岁和中枢神经系统（CNS）受累被确定为与较短的 PFS 相关，而 PLR≥200 和 CNS 受累被确定为 OS 的独立危险因素。LMR、NLR 和 PLR 整合生成了一个“CBC 评分”模型，该模型很好地将成人 T-LBL 患者分为低、中、高危三组，低、中、高危患者的 3 年 OS 分别为 84%、53%和 30%。
结论
总之，在迄今为止最大的成人 T-LBL 队列中，使用简单、广泛可用且易于解释的参数，初步提出了一个“CBC 评分”模型，用于成人 T-LBL 患者的分层。
意义
目前迫切需要确定 T 淋巴母细胞淋巴瘤（T-LBL）高危患者的最佳策略。在迄今为止最大的成人 T-LBL 队列中，应用了简单、廉价、广泛可用的参数，结果显示，淋巴细胞-单核细胞比值（LMR）≤2.8、中性粒细胞-淋巴细胞比值（NLR）≥3.3 和血小板-淋巴细胞比值（PLR）≥200 的患者无进展生存期和总生存期（OS）均较差，在国际预后指数评分 0-2 亚组中差异更为显著。LMR、NLR 和 PLR 整合生成了一个“全血细胞计数评分”模型，低、中、高危患者的 3 年 OS 分别为 84%、53%和 30%。
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