Dynamic Changes Of PLR,NLR And β2-GM During R-CHOP Chemotherapy In Diffuse Large B-cell Lymphoma And Their Value In Prediction And Evaluation Of Efficacy

BackgroundDiffuse large B-cell lymphoma,the most common type of non-Hodgkin lymphoma,is a clinically aggressive malignant tumor.The standard treatment regimen is combined chemotherapy with R-CHOP.The International Prognostic Index（IPI）and the Age-Adjusted International Prognostic Index（aa IPI）play an important role in clinical treatment,but various prognostic assessment models have their shortcomings.place.With the research progress of tumor microenvironment,scholars have made great progress in exploring the role of inflammatory markers and the diagnosis,treatment and prognosis of malignant tumors.At present,the efficacy evaluation of DLBCL is cumbersome and expensive,and a simple and inexpensive clinical inflammatory index to evaluate treatment response is urgently needed.ObjectiveTo explore the influencing factors of efficacy evaluation of DLBCL patients,to evaluate the dynamic changes of neutrophil-to-lymphocyte ratio（NLR）,platelet-to-l ymphocyte ratio（PLR）,β2-microglobulin（β2-GM）in peripheral blood during treatm ent and Its value in the evaluation of clinical efficacy.MethodsAll patients who were hospitalized and diagnosed with diffuse large B-cell lymphoma by histopathological biopsy from July 2018 to December 2021 in the First Affiliated Hospital of Xinxiang Medical College were collected and received at least 6 cycles of standard treatment.The therapeutic effect was evaluated after 6 cycles of treatment,and the dynamic changes of NLR,PLR,β2-GM and other related indicators were monitored before chemotherapy and after the 1st,3rd,and 6th cycles after chemotherapy.SPSS 22.0software was used to analyze the data statistically and establish a Logistic regression model to explore the influencing factors of the disease control rate（DCR）,conduct trend analysis and establish receiver operating characteristic curve（ROC）,through the analysis The role of the area under the curve（AUC）assessment in the evaluation of efficacy.Results1 The study included 143 patients.According to the best cut-off value of ROC,they were divided into two groups: PLR≤240.65 and PLR>240.65.In the PLR>240.65 group,it was found that the number of middle-risk and high-risk groups was more than that of the PLR≤240.65 group（35vs27）,and the PLR>240.65 was often associated with low DCR（P<0.05）;according to the best cut-off value of NLR 4.97,the patients were divided into two groups: NLR≤4.97 and NLR>4.97.In the NLR>4.97 group,the number of patients with disease progression after R-CHOP treatment was higher than that of NLR.≤4.97group（21vs10）,the difference was statistically significant（P<0.05）.2 Logistic univariate analysis related to DCR showed that ECOG≥2,IPI score>2,double-hit/triple-hit,cumulative bone marrow,PLR>240.65,NLR>4.97,elevated β2-GM were associated with low DCR rate,multivariate analysis The results showed that IPI score,PLR>240.65,NLR>4.97,and increased β2-GM were independent influencing factors for poor clinical efficacy evaluation.3 Trend analysis showed that PLR,NLR,β2-GM showed a trend change during R-CHOP treatment in DLBCL patients,that is,it gradually decreased in the DCR group and gradually increased in the PD group.4 The ROC was established by taking whether the patient’s curative effect reached PD as the end point of multivariate analysis.The results showed that the AUCs of PLR,NLR,and β2-GM at the initial diagnosis were 0.784,0.753,and 0.715,respectively.After statistical analysis,P<0.05,which was statistically significant.It shows that the three indicators have guiding significance for the evaluation of curative effect.After 6 cycles of R-CHOP treatment,the AUCs of PLR,NLR,and β2-GM were 0.832,0.902,and 0.982,respectively,which were considered to have guiding significance in the evaluation of the efficacy of patients（P<0.05）.At the same time,a multivariate regression equation was constructed to evaluate the efficacy of patients with the levels of PLR,NLR,and β2-GM at the initial diagnosis and after 6 cycles of treatment.The AUC at the initial diagnosis and after 6 cycles of treatment were 0.867 and 0.998,respectively.The clinical evaluation value（P<0.05）.ConclusionIPI score,PLR>240.65,NLR>4.97,and increased β2-GM were significantly associated with low DCR rates.The monitoring of PLR,NLR and β2-GM at the initial diagnosis has a predictive effect on the efficacy evaluation of DLBCL,and the combination of the three can be used as a new index for efficacy evaluation after 6 cycles of treatment.