Abstract
Inflammation-based prognostic scores, such as the glasgow prognostic score (GPS), prognostic index (PI), prognostic nutritional index (PNI), neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) were related to survival in many solid tumors. Recent study showed that GPS can be used to predict outcome in diffuse large B-cell lymphoma (DLBCL). However, other inflammation related scores had not been reported and it also remained unknown which of them was the most useful to evaluate the survival in DLBCLs. In this retrospective study, a number of 252 newly diagnosed and histologically proven DLBCLs from January 2003 to December 2014 were included. The high GPS, high PI, high NLR, high PLR and low PNI were all associated with poor overall survival (p < 0.05) and event-free survival (p < 0.05) in univariate analysis. Multivariate analysis indicated that GPS (HR = 1.781, 95% CI = 1.065–2.979, p = 0.028) remained an independent prognostic predictor in DLBCL. The c-index of GPS (0.735, 95% CI = 0.645–0.824) was greater than that of PI (0.710, 95% CI = 0.621–0.799, p = 0.602), PNI (0.600, 95% CI = 0.517–0.683, p = 0.001), PLR (0.599, 95% CI = 0.510–0.689, p = 0.029) and NLR (0.572, 95% CI = 0.503–0.642, p = 0.005) by Harrell's concordance index. Especially in DLBCLs treated with R-CHOP, GPS still remained the most powerful prognostic score when comparing with others (p = 0.001 and p < 0.001, respectively for OS and EFS). In conclusion, it is indicated that inflammation-based prognostic scores such as GPS, PI, NLR, PNI and PLR all could be used to predict the outcome of DLBCLs. Among them, GPS is the most powerful indicator in predicting survival in DLBCLs, even in the rituximab era.
Highlights
Diffuse large B-cell lymphoma (DLBCL) is one of the most common subtypes non-Hodgkin lymphomas, characterized by heterogeneity in clinical, immunophenotypic, clinical response and pathogenetics [1]
In diffuse large B-cell lymphoma (DLBCL) treated with R-cyclophosphamide doxorubicin vincristine and prednisone (CHOP), glasgow prognostic score (GPS) still remained the most powerful prognostic score when comparing with others (p = 0.001 and p < 0.001, respectively for Overall survival (OS) and Event-free survival (EFS))
It is indicated that inflammation-based prognostic scores such as GPS, prognostic index (PI), neutrophil lymphocyte ratio (NLR), prognostic nutritional index (PNI) and platelet lymphocyte ratio (PLR) all could be used to predict the outcome of DLBCLs
Summary
Diffuse large B-cell lymphoma (DLBCL) is one of the most common subtypes non-Hodgkin lymphomas, characterized by heterogeneity in clinical, immunophenotypic, clinical response and pathogenetics [1]. Increasing evidence indicated that inflammation-based scores including GPS (a combination of the serum CRP and ALB), PLR (platelet lymphocyte www.impactjournals.com/oncotarget ratio), NLR (neutrophil lymphocyte ratio), PI (a mix of CRP and white blood cell) and PNI (Onodera’s Prognostic Nutritional Index) were useful for predicting outcome in various malignancies [7,8,9,10]. Other inflammation-based scores including NLR, PLR, PI and PNI have not been explored in DLBCL These cost-effective biomarkers are used routinely in the clinical setting and might be used to provide additional information for patients’ outcome. We conducted this retrospective study to explore the prognostic value of GPS, NLR, PLR, PI and PNI in DLBCL patients to identify which one of them is the most useful for evaluating the outcome of DLBCL
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