A Novel Prognostic Marker for Primary CNS Lymphoma: Lactate Dehydrogenase-to-Lymphocyte Ratio Improves Stratification of Patients Within the Low and Intermediate MSKCC Risk Groups

Luca Tamagnone, Yuting Gao, Li Wei, Seok Jin Kim, Liang Wang, Yingzhi He, Yanfang Zheng, Luca Bertero, Alessia Pellerino, Paola Cassoni, Prochazka Katharina Theresa, Alexander Deutsch, Huien Zhan, Jing Lai, Yao Wang, Hua You

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

Abstract Background Primary central nervous system lymphoma (PCNSL) is a highly aggressive and rare extranodal non-Hodgkin lymphoma (NHL). The MSKCC and the IELSG scores represent the most widely used prognostic models, but many changes have occurred in therapeutic protocols since their development. Moreover, many PCNSL patients cannot be classified using the IELSG score. We thus aimed to create a novel, effective and feasible prognostic model for PCNSL. Methods We included 248 PCNSL patients diagnosed with PCNSL. Our primary endpoint was the overall survival (OS) and we used the receiver operating characteristic (ROC) analysis to determine the optimal prognostic cut-off value for LLR (lactate dehydrogenase-to-lymphocyte ratio), neutrophil-to-lymphocyte ratio (NLR) and derived neutrophil-to-lymphocyte ratio (dNLR). Variable associated with OS were evaluated by univariate and multivariate analyses. 124 out of 248 patients were randomly selected as the internal validation cohort. Results By univariate analysis, an age >60 years, Eastern Cooperative Oncology Group performance status (ECOG PS) >1, treatment with radiotherapy alone, high-risk groups of Memorial Sloan Kettering Cancer Center (MSKCC) score, NLR >4.74, dNLR >3.29, and LLR >166.8 were significantly associated with a worse OS. By multivariate analysis, the MSKCC score and LLR were confirmed as independent prognostic parameters for poorer OS. OS, however, was not significantly different between low- and intermediate-risk groups according to the MSKCC score, while LLR proved to be prognostically relevant and was thus used to develop a novel, effective three-tier PCNSL scoring system. Of 124 patients, 84 patients with survival data and LLR data were successfully validated by newly established PCNSL LLR scoring system. Conclusions In the present study, we demonstrate that a high LLR represents an independent unfavorable prognostic parameter in PCNSL patients which can be integrated into an effective prognostic model.
Lingua originaleEnglish
pagine (da-a)1-11
Numero di pagine11
RivistaFrontiers in Oncology
Volume11
DOI
Stato di pubblicazionePubblicato - 2021

Keywords

  • primary central nervous system lymphoma, lactate dehydrogenase-to-lymphocyte ratio
  • neutrophil-to-lymphocyte ratio
  • prognostic parameter, Memorial Sloan Kettering Cancer Center (MSKCC) score,

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