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目的成人霍奇金淋巴瘤(HL)研究显示外周血淋巴细胞绝对值与单核细胞绝对值的比值(absolute lymphocyte count/absolute monocyte count ratio,LMR)具有预后意义。而在儿童HL中鲜有研究,本研究主要探讨LMR在儿童HL中的预后价值。方法回顾性分析中山大学肿瘤防治中心从1998年1月-2013年10月收治的107例初诊年龄<18岁儿童青少年HL的临床资料,收集和分析患者初诊时的外周血淋巴细胞绝对值(absolute lymphocyte count,ALC)、淋巴细胞百分比(1ymphocyte percentage,LYM%)和单核细胞绝对值(absolute monocyte count,AMC)等数据,通过SPSS中受试者工作特征曲线(receiver operating characteristic curve analysis,ROC)获得淋巴细胞绝对值与单核细胞绝对值比值LMR、LYM%、AMC与及ALC的最佳临界值,在该临界值上敏感度与精确度都达到最大值。再进行单因素和多因素分析其与预后的关系。结果 107例儿童HL纳入分析,男80例,女27例,中位年龄10(2~18)岁。Ⅰ期5例,Ⅱ期50例,Ⅲ期33例,Ⅳ期19例。所有患者采用ABVD为基础的化疗方案±放疗。107例患者LMR的最佳临界值是2.15(P=0.006),LMR/≥2.15患者66例,LMR<2.15患者41例。中位随访时间51.2(7~204)个月。全组5年EFS和OS分别为82.3%和96.7%。LMR≥2.15组和LMR<2.15组患者5年EFS分别为87.9%和70.7%(P=0.041)。两组5年OS分别为97.0%和95.1%;P=0.815)。单因素分析LMR、LYM%和Ⅳ期是儿童HL的EFS预后因素;多因素分析LMR为非独立预后因素,仅Ⅳ期为独立预后因素。结论本研究显示儿童HL患者初诊外周血LMR是影响EFS的预后因素之一,值得进一步研究。
Objective Adult Hodgkin Lymphoma (HL) studies have shown prognostic significance of absolute lymphocyte count / absolute monocyte count ratio (LMR). However, there are few studies in childhood HL. This study mainly explored the prognostic value of LMR in childhood HL. Methods A retrospective analysis of Zhongshan University Cancer Center from January 1998 - October 2013 admitted 107 cases of newly diagnosed children aged <18 years of age children HL clinical data collected and analyzed at the time of first diagnosis of peripheral blood lymphocytes absolute value (absolute lymphocyte count (ALC), lymphocyte percentage (LYM%), and absolute monocyte count (AMC) were calculated and analyzed by receiver operating characteristic curve analysis (ROC) The best cut-off value of LMR, LYM%, AMC, and ALC was obtained between the absolute value of lymphocytes and the absolute value of monocytes, at which the sensitivity and accuracy reached the maximum value. Then univariate and multivariate analysis of its relationship with the prognosis. Results A total of 107 children with HL were included in the analysis. There were 80 males and 27 females with a median age of 10 to 2 years. 5 cases of stage Ⅰ, 50 cases of stage Ⅱ, 33 cases of stage Ⅲ, 19 cases of stage Ⅳ. All patients underwent ABVD-based chemotherapy ± radiotherapy. The best cutoff value for LMR in 107 patients was 2.15 (P = 0.006), 66 in LMR / ≥2.15, and 41 in LMR <2.15. The median follow-up time was 51.2 (7 ~ 204) months. The 5-year EFS and OS were 82.3% and 96.7%, respectively. The 5-year EFS of patients with LMR≥2.15 and LMR <2.15 were 87.9% and 70.7%, respectively (P = 0.041). The 5-year OS was 97.0% and 95.1%, respectively; P = 0.815). Univariate analysis showed that LMR, LYM% and IV were the prognostic factors of children with HL. The multivariate analysis showed that LMR was a non-independent prognostic factor and stage IV was independent prognostic factor. Conclusion This study shows that LMR in newly diagnosed peripheral blood of children with HL is one of the prognostic factors affecting EFS, which deserves further study.