| Objective:To explore the value of peripheral blood red blood cell distribution width(RDW)and lymphocyte absolute count(ALC)at initial diagnosis in predicting prognosis in patients with diffuse large B-cell lymphoma(DLBCL).Methods:A retrospective analysis of clinical data and laboratory results of 157 patients with DLBCL diagnosed in Northern Jiangsu People’s Hospital from December1,2012 to December 31,2017,including gender,age,and classification(GCB/non-GCB),Ann Arbor stage,B symptoms,serum lactate dehydrogenase(LDH),Performance status(ECOG score),extranodal involvement,international prognostic index(IPI),disease in bone marrow,disease in gastrointestinal tract,red blood cell distribution width(RDW),lymphocyte absolute count(ALC),hemoglobin concentration(HGB),albumin(ALB),bcl-6 protein expression,ki-67 level,as well as evaluated the treatment effect and overall survival(OS)time of the patients enrolled.60of these patients received CHOP-like chemotherapy regimens and 97 patients received RCHOP-like therapeutic regimens.Statistical analysis was performed using SPSS 22.0software.By plotting the ROC curve,the optimal threshold values for RDW and ALC were determined and their sensitivity and specificity were analyzed.Measurement data subject to normal distribution are expressed as mean±standard deviation,and other measurement data are described by median and interquartile range.The count data is used to indicate the rate.A comparison of the rates between the two groups was performed using theχ~2 test.The mean between the two groups was compared using a t test.Kaplan-Meier survival analysis was used to determine the relationship between different RDW,ALC levels and prognosis.All factors that may affect prognosis were analyzed using the one-factor and multi-factor Cox proportional hazard models.P<0.05indicates statistical significance.RESULTS:1.A total of 157 patients with complete clinical evidence were enrolled.The median age was 63 years(51.5 to 70 years),of which 86 were male(54.8%)and GCB subtypes were 49(31.2%).ECOG score≥2 points in 34 cases(21.7%),Ann Arbor stage III-IV in 115 cases(26.8%),IPI score 0-1 in 47 cases (29.9%),2 points in 39 cases(24.8%),43 cases with 3 points(27.4%),28 cases with 4-5points(17.8%).2.According to the cut-off value of ROC curve and the laboratory reference value,take the RDW boundary value as 13.7%,and divided whole patients into higher RDW group(≥13.7%)and RDW normal group(<13.7%).The cut-off value of ALC was 1.1×10~9/L,patients were divided into lower ALC group(≤1.1×10~9/L)and ALC normal group(>1.1×10~9/L).3.RDW≥13.7%t is more likely to occur in the higher IPI score(P=0.034),ECOG score≥2(P=0.041),Ann Arbor stage III-IV(P=0.028),with B Symptoms(P=0.010),abnormal serum LDH(P=0.010),extranodal involvement>1(P=0.026),disease in marrow infiltration(P=0.010),limited BCL-6 expression(P=0.024),lower hemoglobin(P=0.000),and patients with lower lymphocytes(P=0.028),lower albumin(P=0.000).4.ALC≤1.1×10~9/L is more likely to occur in age>60 years(P=0.035),higher IPI score(P=0.010),Ann Arbor stage III-IV(P=0.047),abnormal serum LDH(P=0.035),lower hemoglobin(P=0.010),lower monocytes(P=0.000),lower albumin(P=0.032).5.Comparing the therapeutic effects between different RDW and ALC groups,it was found that the treatment efficiency of the higher group of RDW and the lower group of ALC was lower than that of the normal group,the difference was statistically significant(RDW:P=0.009,ALC:P=0.047).6.After a median follow-up of 28 months,K-M analysis showed that patients with higher RDW and lower ALC had shorter OS(RDW:P=0.003,ALC:P=0.024), wheather combination with immunotherapy or not.Multivariate Cox regression model suggested that RDW≥13.7%,ALC≤1.0×10~9/L,and ECOG score≥2 were independent risk factors for OS in patients with DLBCL.Conclusion:RDW and ALC at the initial diagnosis can be used as indicators to evaluate the prognosis of patients with DLBCL.RDW≥13.7%and ALC≤1.1×10~9/L may indicate poor prognosis,either chemotherapy alone or combined with immunotherapy. |
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