Impact on the survival of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and monocyte-lymphocyte ratio on prognosis in children with Hodgkin lymphoma

Kubra Ertan; Aysenur Dogru; Buket Kara; Yavuz Koksal

doi:10.15537/smj.2022.43.5.20210916

Article Figures & Data

Tables

View popup

Table 1

- The patients’ demographic and clinical features.

Variables	n (%)
Age, median year (minimum - maximum)	9 year (3-17.5)
Age groups
≤5 years old	11 (21.2)
5-10 years old	17 (32.7)
≥10 years old	24 (46.1)
Gender
Male	25 (48.1)
Female	27 (51.9)
Nationality
Turkish	50 (96.2)
Refugee	2 (3.8)
Symptom duration, median months (minimum - maximum)	1 month (1-24)
Symptoms
Lymphadenopathy	52 (100)
Fever	16 (30.8)
Weight loss	13 (25.0)
Night sweats	10 (19.2)
Pruritus	4 (7.7)
B symptoms	22 (42.3)
Other clinical features
Bulk disease involvements	10 (19.2)
Splenic	14 (26.9)
Bone	5 (9.6)
Pulmonary	4 (7.7)
Bone marrow	2 (3.8)
Liver	1 (1.9)
Stage
I	0 (0.0)
II	22 (42.3)
III	24 (46.2)
IV	6 (11.5)
Risk group
Low	15 (28.8)
Intermediate	16 (30.8)
High	21 (40.4)
Histologic variant
Classical Hodgkin lymphoma
Nodular sclerosis type	28 (53.8)
Mixed cellularity type	18 (34.7)
Lymphocyte rich type	1 (1.9)
Lymphocyte depleted type	0 (0.0)
Unclassified	5 (9.6)
Chemotherapy regimens
Adriamycin, bleomycin sulfate, vinblastine sulfate, and dacarbazine (ABVD)	17 (32.7)
Oncovin, prednisone, procarbazine hydrochloride, and adriamycin (OPPA) or OEPA + COPP	14 (26.9)
OPPA or oncovin, etoposide phosphate, prednisone, and adriamycin (OEPA)	7 (13.5)
ABVD + cyclophosphamide, oncovin, procarbazine hydrochloride, and prednisone (COPP)	7 (13.5)
ABVD + cyclophosphamide, oncovin, prednisone, and dacarbazine (COPDac)	6 (11.5)
Adriamycin, bleomycin sulfate, vincristine sulfate, etoposide, prednisone, and cyclophosphamide	1 (1.9)

Values are presented as a number and (%).

View popup

Table 2

- The patients’ hematological parameters.

Parameters	n (%)
Hemoglobin levels, gr/dL, median (min-max)^*	11.8 (7.1-14.2)
Normal	33 (63.5)
Anemia	19 (36.5)
Leukocyte counts, mm³, median (min-max)^*	9805 (3860-23260)
Normal	37 (71.2)
High	11 (21.2)
Low	4 (7.6)
Neutrophil counts, mm³, mean±SD	7230.8±4535.7
Normal	31 (59.6)
High	20 (38.5)
Low	1 (1.9)
Lymphocyte counts,mm³, mean±SD	2319.1±1040.4
Normal	44 (84.6)
Low	8 (15.4)
Monocyte counts, mm³, mean±SD	718.7±341.2
Normal	32 (61.5)
High	17 (32.7)
Low	3 (5.8)
Platelets counts, mm³, mean±SD	381326.9±133083.3
Normal	40 (76.9)
High	11 (21.2)
Low	1 (1.9)
NLR, median (min-max)^*	2.78 (0.46-56.5)
≤3.17	29 (55.8)
>3.17	23 (44.2)
PLR, median (min-max)^*	156.3 (9.96-2235.0)
≤180	31 (59.6)
>180	21 (40.4)
MLR, median (min-max)^*	0.3 (0.05-2.5)
≤0.29	22 (44.2)
>0.29	30 (55.8)

↵* The distributions of these parameters were not normal. Values are presented as a number and (%). NLR: neutrophil-to-lymphocyte ratio, PLR: platelet-to-lymphocyte ratio, MLR: Monocyte-to-lymphocyte ratio, gr/dL: grams/decilitre, min: minimum, max: maximum, SD: standard deviation

View popup

Table 3

- The changes of lymphocyte count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratios according to clinical and laboratory features.

Clinical and laboratory features	Lymphocyte counts (/mm³)		Neutrophil-to-lymphocyte ratio		Platelet-to-lymphocyte ratio		Monocyte-to-lymphocyte ratio
Clinical and laboratory features	Median (min-max)	P-values	Median (min-max)	P-values	Median (min-max)	P-values	Median (min-max)	P-values
B symptoms, mean±SD
Absent (n=30)	2490.8±927.4	0.167	2.11 (0.46-8.9)	0.003^{^*}	137.6 (76.7-425.0)	0.017^{^*}	0.29 (0.06-0.8)	0.005^{^*}
Present (n=22)	2084.9±1158.3	0.167	4.67 (0.75-56.5)	0.003^{^*}	218.3 (9.96-2235.0)	0.017^{^*}	0.38 (0.05-2.5)	0.005^{^*}
Bulky disease
Absent (n=42)	2320 (400-4920)	0.007^{^*}	2.5 (0.46-7.75)	0.002^{^*}	139.5 (9.96-812.5)	0.001^{^*}	0.3 (0.05-2.5)	0.057
Present (n=10)	1560 (200-5250)	0.007^{^*}	7.46 (1.34-56.5)	0.002^{^*}	343.6 (87.62-2235.0)	0.001^{^*}	0.37 (0.21-1.5)	0.057
Erythrocyte sedimentation rate, mean±SD
≤40 mm/h (n=27)	2429.0±1061.6	0.434	2.12 (0.46-56.5)	0.042^{^*}	140.9 (9.96-2235)	0.268^{^*}	0.29 (0.05-1.5)	0.043^{^*}
>40 mm/h (n=25)	2200.4±1025.2	0.434	3.42 (0.75-8.0)	0.042^{^*}	165.87 (77.39-812.5)	0.268^{^*}	0.35 (0.12-2.5)	0.043^{^*}
Lactate dehydrogenase
≤2 x UNL (n=48)	2250 (200-5250)	0.655^{^*}	2.76 (0.46-56.5)	0.31^{^*}	152.3 (9.96-2235.0)	0.180^{^*}	0.3 (0.05-1.5)	0.216
>2 x UNL (n=4)	2250 (400-2780)	0.655^{^*}	5.45 (1.15-8)	0.31^{^*}	274.26 (130.74-812.5)	0.180^{^*}	0.56 (0.23-2.5)	0.216
Stage
II (n=22)	2260 (1160-5250)	0.323^{^*}	2.62 (0.46-13.1)	0.166^{^*}	139.5 (9.96-343.6)	0.079^{^*}	0.29 (0.13-0.67)	0.064^*
III (n=24)	2200 (200-4080)		2.7 (0.57-56.5)		171.9 (76.7-2235.0)		0.3 (0.05-1.5)
IV (n=6)	1800 (400-2900)		5.41 (2.1-8)		256.0 (109.3-812.5)		0.38 (0.27-2.5)
Risk group
Low (n=15)	2225 (1160-5250)	0.415^{^*}	1.85 (0.46-4.33)	0.117^{^*}	138.03 (87.62-258.62)	0.103^{^*}	0.25 (0.13-0.45)	0.043^{^*}
Intermediate (n=16)	2350 (1000-4080)		2.88 (0.57-13.09)		173.53 (76.67-425.0)		0.3 (0.06-0.8)
High (n=21)	2105 (200-4920)		3.42 (0.75-56.5)		171.86 (9.96-2235.0)		0.36 (0.05-2.5)
Outcomes
Alive (n=48)	2300 (1000-5250)	0.004^{^*}	2.65 (0.46-13.09)	0.017^{^*}	146.5 (9.96-523.1)	0.004^{^*}	0.3 (0.05-0.83)	0.008^{^*}
Dead (n=4)	780 (200-1850)	0.004^{^*}	6.82 (3.28-56.5)	0.017^{^*}	543.0 (258.6-2235)	0.004^{^*}	0.98 (0.37-2.5)	0.008^{^*}

↵* Since the distribution of these variables was not normal, non-parametric tests were used. Also, median plus minimum-maximum values were given as descriptive statistics for these variables. UNL: upper normal limit, SD: standard deviation

View popup

Table 4

- Evaluation of the factors effect on survival analyzes.

Variables	Overall survival
Variables	Estimate	SE	P-values
B symptoms
Absent (n=30)	96.0	3.5	0.229
Present (n=22)	85.2	8	0.229
Bulky disease
Absent (n=42)	94.9	3.5	0.088
Present (n=10)	71.1	18	0.088
Erythrocyte sedimentation rate
≤40 mm/h (n=27)	91.5	5.8	0.996
>40 mm/h (n=25)	90.4	6.6	0.996
Hemoglobin
Normal (n=33)	92.2	5.2	0.632
Anemia (n=19)	89.2	7.2	0.632
Leukocyte counts
Normal (n=37)	91.2	4.8	0.852
High (n=11)	87.5	11.7
Low (n=4)^a
Neutrophil counts
Normal (n=31)	93.1	4.7	0.857
High (n=21)	87.2	8.6	0.857
Lymphocyte counts
Normal (n=44)	96.7	3.7	<0.0001
Low (n=8)	60.0	18.2	<0.0001
Monocyte counts
Normal (n=32)	89.0	6.1	0.842
High (n=17)	93.3	6.4
Low (n=3)^a
Platelet counts
Normal (n=40)	91.9	4.5	0.96
High (n=11)	87.5	11.7
Low (n=1)^a
Neutrophil-to-lymphocyte ratio
≤3.17 (n=29)	100	-	0.018
>3.17 (n=23)	78.6	9.7	0.018
Platelet-to-lymphocyte ratio
≤180 (n=30)	100	-	0.009
>180 (n=22)	76.5	10.6	0.009
Monocyte-to-lymphocyte ratio
≤0.29 (n=23)	100	-	0.059
>0.29 (n=29)	83.1	7.9	0.059
Risk group
Low (n=15)	92.9	6.9	0.895
Intermediate (n=16)	90.9	8.7
High (n=21)	90.2	6.6