Prognostic Value Of Geriatric Nutritional Risk Index In Diffuse Large B Cell Lymphoma

Purpose: To evaluate the prognostic value of geriatric nutritional risk index in patients with not otherwise specified diffuse large B cell lymphoma(DLBCL,NOS).Method: Data of 249 patients diagnosed as de novo DLBCL in Fujian Medical University Union Hospital between December 2013 and December 2017 according to WHO classification,were analyzed retrospectively.All patients are older than 17 years old,Collection of relevant clinical data including blood routine,blood biochemistry,bone marrow routine,height,weight,chest CT,abdominal CT and/or PET-CT,etc.,clinical stage according to Ann Arbor criteria,according to patient age,physical fitness(ECOG)Score,extranodal involvement,clinical stage,and LDH for IPI and NCCN-IPI scores.The criteria for judging the efficacy of chemotherapy are based on the guidelines for non-Hodgkin's lymphoma published by the National Comprehensive Cancer Network in 2015.To analyze the prognostic significance of GNRI in patients with not otherwise specified diffuse large B-cell lymphoma.Statistical analysis was performed using SPSS 22.0 software.The two-sample rate was compared by chi-square test.The Kaplan-Meier method was used to calculate the 3-year PFS and OS,Log-rank was compared between groups,and the survival curve was drawn.Univariate and multivariate analyses were performed on the prognostic factors by Cox regression model.All the tests were bilateral tests.P<0.05 was considered statistically significant.Result: A total of 249 cases [142 cases male and 107 ones female with the median age of 60(18-85)years old] were enrolled.136 patients(54.6%)with GNRI?96.6,with a median age of 60 years(23-85 years),113 patients(45.4%)with GNRI<96.6,and a median age of 60 years(18-85).GNRI?96.6 group had fewer B symptoms such as fever,night sweats,and weight loss(P=<0.001),GNRI<96.6 group had high ECOG score(>1),more extranodal involvement(>1),high LDH,high IPI score,high NCCN-IPI score,etc.,and more prone to bone marrow involvement.The 3-year overall survival rate and 3-year progression-free survival rate in the GNRI<96.6 group and the GNRI?96.6 group were(67.7% vs 46.6%,P=0.000),(61.9% vs 44.6%,P=0.001),respectively,The differences were statistically significant.Patients who received R-CHOP or R-CHOP-like regimen and had GNRI ? 96.6 had a longer 3-year OS(76.3% vs 53.6%,P=0.002)and a 3-year PFS(73.2% vs 50.2%,P=0.001).Here were no significant differences in 3-year OS(68.0% vs 49.2%,P=0.169)and 3-year PFS(49.6% vs 29.6%,P=0.697)between the two groups treated with CHOP or CHOP-like regimens.There was no significant difference in the effects of GNRI on OS in low-risk group,intermediate-low-risk group,intermediate-high-risk group and high-risk group.Conclusion: The GNRI ? 96.6 group had the following characteristics: less B symptoms,bone marrow involvement,elevated LDH,fewer extranodal involvement,lower IPI,NCCN-IPI,and ECOG scores;patients with GNRI?96.6 had longer overall survival and Progression-free survival;GNRI had no statistically significant difference in OS of NCCN-IPI risk stratification low-risk group,middle-low-risk group,middle-high-risk group,and high-risk group;COX multivariate regression analysis suggested that GNRI was not diffuse Independent prognostic factors in patients with large B-cell lymphoma.