Prognostic Value of the Modified Systemic Inflammation Score in Patients With Extranodal Natural Killer/T-Cell Lymphoma
BackgroundExtranodal natural killer/T-cell lymphoma (ENKTL) is a rare and extremely malignant tumor. The systemic inflammation score (SIS), which is based on the pretreatment level of lymphocyte-to-monocyte ratio (LMR) and serum albumin (Alb), has been shown to be of prognostic value in a number of c...
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Frontiers Media S.A.
2020-09-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fphar.2020.593392/full |
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| author | He Huang He Huang He Huang Li Min Chen Li Min Chen Li Min Chen Xiao Jie Fang Xiao Jie Fang Xiao Jie Fang Cheng Cheng Guo Cheng Cheng Guo Cheng Cheng Guo Xiao Ping Lin Xiao Ping Lin Xiao Ping Lin Huang Ming Hong Huang Ming Hong Huang Ming Hong Huang Ming Hong Xi Li Xi Li Xi Li Zhao Wang Zhao Wang Zhao Wang Ying Tian Ying Tian Ying Tian Mei Ting Chen Mei Ting Chen Mei Ting Chen Yu Yi Yao Yu Yi Yao Yu Yi Yao Zegeng Chen Zegeng Chen Zegeng Chen Xiao Qian Li Xiao Qian Li Xiao Qian Li Fei Pan Fei Pan Fei Pan |
| author_facet | He Huang He Huang He Huang Li Min Chen Li Min Chen Li Min Chen Xiao Jie Fang Xiao Jie Fang Xiao Jie Fang Cheng Cheng Guo Cheng Cheng Guo Cheng Cheng Guo Xiao Ping Lin Xiao Ping Lin Xiao Ping Lin Huang Ming Hong Huang Ming Hong Huang Ming Hong Huang Ming Hong Xi Li Xi Li Xi Li Zhao Wang Zhao Wang Zhao Wang Ying Tian Ying Tian Ying Tian Mei Ting Chen Mei Ting Chen Mei Ting Chen Yu Yi Yao Yu Yi Yao Yu Yi Yao Zegeng Chen Zegeng Chen Zegeng Chen Xiao Qian Li Xiao Qian Li Xiao Qian Li Fei Pan Fei Pan Fei Pan |
| author_sort | He Huang |
| collection | DOAJ |
| description | BackgroundExtranodal natural killer/T-cell lymphoma (ENKTL) is a rare and extremely malignant tumor. The systemic inflammation score (SIS), which is based on the pretreatment level of lymphocyte-to-monocyte ratio (LMR) and serum albumin (Alb), has been shown to be of prognostic value in a number of cancers. We integrate several other pretreatment serum inflammatory indicators, including the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), serum C-reactive protein (CRP) and albumin (Alb) level, to establish a modified systemic inflammatory scoring system to predict clinical outcomes of ENKTL.MethodsA total of 184 patients with newly diagnosed ENKTL was retrospectively investigated. Systemic inflammatory indexes, including NLR, LMR, CRP, and Alb level were reviewed. Receiver operating characteristic (ROC) curve analysis was carried out to obtain the optimal cut-off value. The associations between cutoff values and overall survival (OS) were analyzed by Kaplan–Meier curves and Cox proportional models.ResultsThe median age of patients was 44.0 years, ranging from 15 to 82 years. There were 129 (70.1%) male patient. About 57.1% of patients had stage III or IV disease. The optimal cut-off values of NLR and LMR in predicting OS were 3.1 and 2.4, respectively. The clinical standard of CRP and Alb levels at 10 and 40 mg/L, respectively, were chosen as the optimal cut-off values. By multivariate analysis, hemophilic syndrome (hazard ratio [HR]: 10.540, 95% confidence interval [CI]: 3.440–32.291, P < 0.001), advanced Ann Arbor stages (III–IV) (HR: 4.606, 95% CI: 1.661–12.774, P = 0.003), paranasal sinus invasion (HR: 2.323, 95% CI: 1.069–5.047, P = 0.033), NLR ≥ 3.1 (HR: 3.019, 95% CI: 1.317–6.923, P = 0.009), Alb level of <40 mg/L (HR: 0.350, 95% CI: 0.134–0.915, P = 0.032), and radiation therapy (HR: 0.430, 95% CI: 0.205–0.901, P = 0.025) were independent protective factors for ENKTL. We combined two inflammatory indexes NLR and Alb level to establish a modified systemic inflammation score (mSIS). These 184 patients were divided into 3 groups: group 1 (mSIS score of 0), group 2 (mSIS score of 1), and group 3 (mSIS score of 2). The mean OS of these three groups were 42 months (95% CI: 31.4–53.12), 77 months (95% CI: 68.5–87.5), and 89 months (95% CI: 71.4–82.7), respectively (P < 0.001). The Harrell’s concordance index (C-index) of mSIS is 0.725. The mSIS could be used to discriminate patients categorized in the low-risk group of International Prognostic Index (IPI) (P < 0.001) and the low-risk and intermediate-risk prognostic index of natural killer cell lymphoma (PINK) group (P = 0.019).ConclusionThe pretreatment mSIS could be an independent prognostic factor for OS in patients with ENKTL and warrants further research. |
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| spelling | doaj.art-9bdfb7f2f4774834971bd6a1fd7e60462022-12-21T23:47:45ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122020-09-011110.3389/fphar.2020.593392593392Prognostic Value of the Modified Systemic Inflammation Score in Patients With Extranodal Natural Killer/T-Cell LymphomaHe Huang0He Huang1He Huang2Li Min Chen3Li Min Chen4Li Min Chen5Xiao Jie Fang6Xiao Jie Fang7Xiao Jie Fang8Cheng Cheng Guo9Cheng Cheng Guo10Cheng Cheng Guo11Xiao Ping Lin12Xiao Ping Lin13Xiao Ping Lin14Huang Ming Hong15Huang Ming Hong16Huang Ming Hong17Huang Ming Hong18Xi Li19Xi Li20Xi Li21Zhao Wang22Zhao Wang23Zhao Wang24Ying Tian25Ying Tian26Ying Tian27Mei Ting Chen28Mei Ting Chen29Mei Ting Chen30Yu Yi Yao31Yu Yi Yao32Yu Yi Yao33Zegeng Chen34Zegeng Chen35Zegeng Chen36Xiao Qian Li37Xiao Qian Li38Xiao Qian Li39Fei Pan40Fei Pan41Fei Pan42Department of Medical Oncology, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaState Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaCollaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, ChinaDepartment of Medical Oncology, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaState Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaCollaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, ChinaDepartment of Medical Oncology, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaState Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaCollaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, ChinaState Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaCollaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, ChinaDepartment of Neurosurgery, Sun Yat-sen University Cancer Center, Guangzhou, ChinaState Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaCollaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, ChinaDepartment of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, ChinaDepartment of Medical Oncology, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaState Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaCollaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, ChinaDepartment of Medical Oncology, Sun Yat-sen Memorial Hospital, Guangzhou, ChinaDepartment of Medical Oncology, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaState Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaCollaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, ChinaDepartment of Medical Oncology, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaState Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaCollaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, ChinaDepartment of Medical Oncology, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaState Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaCollaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, ChinaDepartment of Medical Oncology, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaState Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaCollaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, ChinaDepartment of Medical Oncology, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaState Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaCollaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, ChinaDepartment of Medical Oncology, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaState Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaCollaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, ChinaDepartment of Medical Oncology, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaState Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaCollaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, ChinaDepartment of Medical Oncology, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaState Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, ChinaCollaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, ChinaBackgroundExtranodal natural killer/T-cell lymphoma (ENKTL) is a rare and extremely malignant tumor. The systemic inflammation score (SIS), which is based on the pretreatment level of lymphocyte-to-monocyte ratio (LMR) and serum albumin (Alb), has been shown to be of prognostic value in a number of cancers. We integrate several other pretreatment serum inflammatory indicators, including the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), serum C-reactive protein (CRP) and albumin (Alb) level, to establish a modified systemic inflammatory scoring system to predict clinical outcomes of ENKTL.MethodsA total of 184 patients with newly diagnosed ENKTL was retrospectively investigated. Systemic inflammatory indexes, including NLR, LMR, CRP, and Alb level were reviewed. Receiver operating characteristic (ROC) curve analysis was carried out to obtain the optimal cut-off value. The associations between cutoff values and overall survival (OS) were analyzed by Kaplan–Meier curves and Cox proportional models.ResultsThe median age of patients was 44.0 years, ranging from 15 to 82 years. There were 129 (70.1%) male patient. About 57.1% of patients had stage III or IV disease. The optimal cut-off values of NLR and LMR in predicting OS were 3.1 and 2.4, respectively. The clinical standard of CRP and Alb levels at 10 and 40 mg/L, respectively, were chosen as the optimal cut-off values. By multivariate analysis, hemophilic syndrome (hazard ratio [HR]: 10.540, 95% confidence interval [CI]: 3.440–32.291, P < 0.001), advanced Ann Arbor stages (III–IV) (HR: 4.606, 95% CI: 1.661–12.774, P = 0.003), paranasal sinus invasion (HR: 2.323, 95% CI: 1.069–5.047, P = 0.033), NLR ≥ 3.1 (HR: 3.019, 95% CI: 1.317–6.923, P = 0.009), Alb level of <40 mg/L (HR: 0.350, 95% CI: 0.134–0.915, P = 0.032), and radiation therapy (HR: 0.430, 95% CI: 0.205–0.901, P = 0.025) were independent protective factors for ENKTL. We combined two inflammatory indexes NLR and Alb level to establish a modified systemic inflammation score (mSIS). These 184 patients were divided into 3 groups: group 1 (mSIS score of 0), group 2 (mSIS score of 1), and group 3 (mSIS score of 2). The mean OS of these three groups were 42 months (95% CI: 31.4–53.12), 77 months (95% CI: 68.5–87.5), and 89 months (95% CI: 71.4–82.7), respectively (P < 0.001). The Harrell’s concordance index (C-index) of mSIS is 0.725. The mSIS could be used to discriminate patients categorized in the low-risk group of International Prognostic Index (IPI) (P < 0.001) and the low-risk and intermediate-risk prognostic index of natural killer cell lymphoma (PINK) group (P = 0.019).ConclusionThe pretreatment mSIS could be an independent prognostic factor for OS in patients with ENKTL and warrants further research.https://www.frontiersin.org/article/10.3389/fphar.2020.593392/fullextranodal natural killer/T cell lymphomasystemic inflammation scoreneutrophil-lymphocyte ratioalbuminprognosis |
| spellingShingle | He Huang He Huang He Huang Li Min Chen Li Min Chen Li Min Chen Xiao Jie Fang Xiao Jie Fang Xiao Jie Fang Cheng Cheng Guo Cheng Cheng Guo Cheng Cheng Guo Xiao Ping Lin Xiao Ping Lin Xiao Ping Lin Huang Ming Hong Huang Ming Hong Huang Ming Hong Huang Ming Hong Xi Li Xi Li Xi Li Zhao Wang Zhao Wang Zhao Wang Ying Tian Ying Tian Ying Tian Mei Ting Chen Mei Ting Chen Mei Ting Chen Yu Yi Yao Yu Yi Yao Yu Yi Yao Zegeng Chen Zegeng Chen Zegeng Chen Xiao Qian Li Xiao Qian Li Xiao Qian Li Fei Pan Fei Pan Fei Pan Prognostic Value of the Modified Systemic Inflammation Score in Patients With Extranodal Natural Killer/T-Cell Lymphoma Frontiers in Pharmacology extranodal natural killer/T cell lymphoma systemic inflammation score neutrophil-lymphocyte ratio albumin prognosis |
| title | Prognostic Value of the Modified Systemic Inflammation Score in Patients With Extranodal Natural Killer/T-Cell Lymphoma |
| title_full | Prognostic Value of the Modified Systemic Inflammation Score in Patients With Extranodal Natural Killer/T-Cell Lymphoma |
| title_fullStr | Prognostic Value of the Modified Systemic Inflammation Score in Patients With Extranodal Natural Killer/T-Cell Lymphoma |
| title_full_unstemmed | Prognostic Value of the Modified Systemic Inflammation Score in Patients With Extranodal Natural Killer/T-Cell Lymphoma |
| title_short | Prognostic Value of the Modified Systemic Inflammation Score in Patients With Extranodal Natural Killer/T-Cell Lymphoma |
| title_sort | prognostic value of the modified systemic inflammation score in patients with extranodal natural killer t cell lymphoma |
| topic | extranodal natural killer/T cell lymphoma systemic inflammation score neutrophil-lymphocyte ratio albumin prognosis |
| url | https://www.frontiersin.org/article/10.3389/fphar.2020.593392/full |
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