Clinical Study Of Prognostic Significance Of RDW And NLR In Patients With Diffuse Large B Cell Lymphoma

Objective: To explore the value of peripheral blood erythrocyte distribution width(RDW)level and neutrophil absolute/lymphocyte absolute ratio(NLR)in predicting the prognosis of newly diagnosed diffuse large B-cell lymphoma(DLBCL).Methods:1.Retrospective analysis was performed on 117 DLBCL patients who were first treated in the First Affiliated Hospital of Hainan Medical University.Clinical data and laboratory examination results of these patients were collected,and the optimal thresholds of RDW and NLR were determined by drawing ROC curves.2.Chi-square test and t test were used to analyze the correlation between different levels of RDW and NLR and clinical characteristics,laboratory test results and treatment effects.The survival curves of DLBCL patients in different RDW and NLR groups were plotted by Kaplan-Meier method,and the differences of survival curves between different levels of RDW and NLR were compared by Log-rank test.3.Univariate analysis and multivariate analysis were performed by binary Logistic regression model and Cox proportional risk regression model,respectively,to find the factors that might affect the overall survival rate(OS)of patients.Results :(1)The optimal cut off value of RDW is 13.95%,RDW ≥ 13.95% was associated with higher IPI score(P=0.005),ANN Arbor clinical staging III-IV(P=0.020),lower hemoglobin(P<0.001),lower albumin(P=0.001),and first-line treatment failure(P<0.001).High RDW was associated with poorer median OS(9months vs.17 months,P=0.004).In the R-CHOP treatment group,the high RDW group had a worse median OS than the low RDW group(5 months vs.18 months,P=0.035).(2)1.97 is the optimal critical value of NLR,NLR≥1.97 was associated with higher IPI score(P=0.015),abnormal LDH(P=0.002),lower hemoglobin(P<0.001),lower albumin(P=0.027),and ANN Arbor clinical stage III-IV(P<0.001).Median OS was worse in the high NLR group,but the difference was not statistically significant(14 months vs.15 months,P=0.900).Both CHOP and R-CHOP showed poor median OS in the high NLR group,but there was no statistically significant difference(CHOP: 10.5 months vs.14 months,P=0.963;R-CHOP group: 13 months vs.16 months,P=0.695).(3)Univariate analysis showed age ≥60 years old(P=0.001),N-GCB source(P=0.008),ECOG score ≥2 points(P=0.023),high IPI score(P=0.012),number of cases ≥ 1(P=0.020),RDW ≥ 13.95%(P=0.037),and elevated LDH(P=0.037)=0.018)is associated with poor OS.In the multivariate analysis results,age≥60 years(P= 0.020),ECOG≥2 points(P=0.005),N-GCB origin(P= 0.039),and high RDW(P=0.013)were associated with poor OS.Conclusion :(1)High RDW levels tend to occur in patients with higher IPI score,late Ann Arbor clinical staging,low albumin concentration,and low hemoglobin concentration.High RDW levels may indicate poor first-line treatment outcomes.(2)High NLR tended to occur in patients with higher IPI score,abnormal LDH,Ann Arbor clinical stage III-IV,low hemoglobin,and low albumin,and NLR levels were not predictive of first-line treatment outcomes.(3)High RDW at initial diagnosis may be an adverse prognostic factor for DLBCL patients,while high NLR may not be an adverse prognostic factor.