红细胞体积分布宽度与淋巴细胞绝对值比值在结外NK/T细胞淋巴瘤患者中的预后价值  

Prognostic value of the ratio of red cell volume distribution width to absolute lymphocyte count in patients with extranodal NK/T-cell lymphoma

作　　者：徐添姿 李怡[1] 刘艺欣 毛明玉 宁彪 魏永长[1] Tian-Zi XU;Yi LI;Yi-Xin LIU;Ming-Yu MAO;Biao NING;Yong-Chang WEI(Department of Gastrointestinal Tumors Radiation and Medical Oncology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院胃肠肿瘤放化疗科,武汉430071

出　　处：《医学新知》2023年第6期417-428,共12页New Medicine

基　　金：国家自然科学基金面上项目(81673033)。

摘　　要：目的本研究旨在评估红细胞体积分布宽度(red cell volume distribution width,RDW)与淋巴细胞绝对值(absolute lymphocyte count,ALC)比值(RDW to ALC ratio,RLR)在结外NK/T细胞淋巴瘤(extranodal NK/T-cell lymphoma,ENKTL)患者中的临床价值,并为其风险分层提供信息。方法回顾性分析2013年4月至2022年5月武汉大学中南医院确诊的ENKTL患者的临床资料,采用Kaplan-Meier曲线和Cox比例风险模型分析RLR的预后价值。通过整合RLR分别建立改良的国际预后评分(international prognostic index,IPI)、韩国预后指数(Korean prognostic index,KPI)、NK/T细胞淋巴瘤预后指数(prognostic model of natural killer lymphoma,PINK)、列线图修订风险指数(nomogram-revision risk index,NRI)模型,并通过受试者工作特征曲线对其进行验证。结果共纳入72例ENKTL患者,不同RLR水平的ENKTL患者在年龄、ECOG PS评分、IPI评分、NRI评分、LDH水平和B症状方面差异具有统计学意义(P<0.05)。本研究中位随访时间为43个月,Kaplan-Meier曲线显示,低RLR组(RLR<10.2)患者3年PFS率(50.6%vs.28.8%,P=0.032)和3年OS率(79.2%vs.40.8%,P=0.001)显著高于高RLR组(RLR≥10.2)。单因素分析显示,RLR≥10.2[HR=4.120,95%CI(1.643,10.333),P=0.003]、ALC<1.0×10^(9)/L[HR=3.793,95%CI(1.712,8.403),P=0.001]、RDW≥13.6[HR=2.874,95%CI(1.199,6.886),P=0.018]均与ENKTL患者OS的预后不良相关。调整化疗方案(含天冬酰胺酶)后,多因素分析结果显示,ALC<1.0×10^(9)/L[HR=3.146,95%CI(1.249,7.924),P=0.015]和RLR≥10.2[HR=3.228,95%CI(1.077,9.680),P=0.036]仍与ENKTL患者的OS预后不良显著相关。在Ann Arbor分期Ⅰ~Ⅱ期患者中,多因素分析分析显示,ALC<1.0×10^(9)/L[HR=3.970,95%CI(1.173,13.436),P=0.027]、ECOG PS≥2分[HR=4.261,95%CI(1.219,14.900),P=0.023]是早期患者OS的独立危险因素。分层分析显示,RLR有助于ENKTL患者的危险分层。此外,整合RLR可为IPI、KPI、PINK和NRI模型提供额外的预后信息。结论ALC可作为早期ENKTL患者预后�Objective To evaluate the clinical value of red cell volume distribution width(RDW)to absolute lymphocyte count(ALC)ratio(RLR)in extranasal natural killer/T-cell lymphoma(ENKTL),and to provide information for better risk stratification.Method Clinical data of patients with ENKTL diagnosed in Zhongnan Hospital of Wuhan University from April 2013 to May 2022 were retrospectively analyzed.Kaplan-Meier curve and Cox proportional risk model were used to analyze the prognostic value of RLR.By integrating RLR,improved international prognostic index(IPI),Korean prognostic index(KPI),prognostic model of natural killer lymphoma(PINK)and nomogram-revision risk index(NRI)models were established respectively,and verified by subject operating characteristic curve.Results 72 ENKTL patients were included.There were statistically significant differences in age,ECOG PS score,IPI score,NRI score,LDH level and B symptoms(P<0.05)in ENKTL patients with different RLR levels.The median follow-up time of this study was 43 months.The Kaplan-Meier curve showed that the 3-year PFS rate(50.6%vs.28.8%,P=0.032)and the 3-year OS rate(79.2%vs.40.8%,P=0.001)were significantly higher than those in the high RLR group(RLR≥10.2).Univariate analysis showed that RLR≥10.2[HR=4.120,95%CI(1.643,10.333),P=0.003],ALC<1.0×10^(9)/L[HR=3.793,95%CI(1.712,8.403),P=0.001],RDW≥13.6[HR=2.874,95%CI(1.199,6.886),P=0.018]were all related to poor prognosis of OS in patients with ENKTL.After adjusting the chemotherapy regimen(with or without asparaginase),multivariate analysis showed that ALC<1.0×10^(9)/L[HR=3.146,95%CI(1.249,7.924),P=0.015]and RLR≥10.2[HR=3.228,95%CI(1.077,9.680),P=0.036]were still significantly associated with poor prognosis of OS in patients with ENKTL;in Ann Arbor stage Ⅰ~Ⅱ patients,multivariate analysis showed that ALC<1.0×10^(9)/L[HR=3.970,95%CI(1.173,13.436),P=0.027],ECOG PS≥2 points[HR=4.261,95%CI(1.219,14.900),P=0.023]were independent risks of OS in early patients factor.Stratified analysis showed that RLR contributed to risk s

关 键 词：结外NK/T细胞淋巴瘤 预后 红细胞体积分布宽度 淋巴细胞绝对值 

分 类 号：R733.1[医药卫生—肿瘤]