Inflammatory and Nutritional Biomarker in Different Subtypes of Early Stage Diffuse Large B-Cell Lymphoma: Towards a Diagnostic Model.

IF 2.5 4区医学 Q3 ONCOLOGY

Cancer Management and Research Pub Date : 2025-07-12 eCollection Date: 2025-01-01 DOI:10.2147/CMAR.S527855

Amaylia Oehadian, Stephanie Victoria Gunadi, Lusi Mersiana, Evan Susandi, Indra Wijaya, Januar Wibawa Martha, Rudi Supriyadi, Delita Prihatni

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引用次数: 0

Abstract

Background: Diffuse Large B-Cell Lymphoma (DLBCL) is a heterogeneous malignancy with distinct Germinal Center B-Cell Like (GCB) and non-GCB subtypes. Accurate subtyping is crucial due to differences in prognosis and treatment response. While gene expression profiling is the gold standard, it is often unavailable in low-resource settings. Inflammatory and nutritional biomarkers such as Systemic Immune-Inflammation Index (SII), Prognostic Nutritional Index (PNI), and Advanced Lung Cancer Inflammation Index (ALI) offer a practical alternative. This study aims to evaluate their diagnostic potential in early-stage DLBCL subtypes.

Methods: A cross-sectional analysis was conducted on 60 early stage DLBCL patients (30 GCB, 30 non-GCB) at Dr Hasan Sadikin General Hospital Bandung. Clinical characteristics, hematological parameters, and inflammation-based indices (SII, PNI, and ALI) were evaluated. Differences between subtypes were analyzed using the Mann-Whitney U-test, and Receiver Operating Characteristic (ROC) analysis was used to determine diagnostic performance.

Results: The median SII was significantly higher in non-GCB compared with GCB (982,575; IQR: 609,112-2,239,917 vs 575,598; IQR: 454,578-886,426, p = 0.014). Conversely, PNI was higher in GCB compared to non-GCB group (49.18; IQR: 46.38-56.38 vs 45.96; IQR 40.05-52.28, p = 0.011). ALI values were also higher in the GCB than non-GCB (44.14; IQR: 27.69-67.18 vs 24.51; IQR: 14.34-42.47,p=0.003). ROC analysis revealed that ALI had the highest diagnostic accuracy (AUC = 0.724; 95% CI: 0.593-0.831), followed by SII (AUC = 0.685, 95% CI: 0.552-0.799) and PNI (AUC = 0.691 95% CI: 0.558-0.804). Optimal cut-off values were ≤1,234,133 for SII, >43.27 for PNI, and >27.41 for ALI. ALI demonstrated the best balance between sensitivity (76.7%) and specificity (63.3%), making it the most reliable marker for distinguishing DLBCL subtypes.

Conclusion: SII, PNI, and ALI differ significantly between DLBCL subtypes. These findings suggest that integrating these indices into a diagnostic model could enhance risk stratification and guide therapeutic decision-making in DLBCL. Further studies with larger cohorts are warranted to validate these findings.

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早期弥漫性大b细胞淋巴瘤不同亚型的炎症和营养生物标志物：建立诊断模型

背景：弥漫性大b细胞淋巴瘤（DLBCL）是一种异质性恶性肿瘤，具有不同的生发中心b细胞样（GCB）和非GCB亚型。由于预后和治疗反应的差异，准确的亚型是至关重要的。虽然基因表达谱是金标准，但在资源匮乏的环境中往往无法使用。炎症和营养生物标志物，如全身免疫炎症指数（SII）、预后营养指数（PNI）和晚期肺癌炎症指数（ALI）提供了一个实用的替代方案。本研究旨在评估其在早期DLBCL亚型中的诊断潜力。方法：对万隆市Dr Hasan Sadikin总医院的60例早期DLBCL患者（GCB 30例，非GCB 30例）进行横断面分析。评估临床特征、血液学参数和炎症指标（SII、PNI和ALI）。采用Mann-Whitney u检验分析各亚型之间的差异，采用受试者工作特征（ROC）分析确定诊断效能。结果：非GCB组的中位SII明显高于GCB组(982,575；IQR: 609,112-2,239,917 vs 575,598；IQR: 454,578-886,426, p = 0.014)。相反，GCB组的PNI高于非GCB组(49.18；IQR: 46.38-56.38 vs 45.96；IQR = 40.05-52.28, p = 0.011)。GCB组的ALI值也高于非GCB组(44.14；IQR: 27.69-67.18 vs 24.51；差:14.34 - -42.47,p = 0.003)。ROC分析显示ALI的诊断准确率最高(AUC = 0.724；95% CI: 0.593-0.831)，其次是SII （AUC = 0.685, 95% CI: 0.552-0.799）和PNI （AUC = 0.691, 95% CI: 0.558-0.804）。SII的最佳临界值为≤1,234,133，PNI为>43.27，ALI为>27.41。ALI在敏感性（76.7%）和特异性（63.3%）之间表现出最佳的平衡，使其成为区分DLBCL亚型的最可靠的标志物。结论：SII、PNI和ALI在DLBCL亚型间存在显著差异。这些发现表明，将这些指标整合到诊断模型中可以增强DLBCL的风险分层并指导治疗决策。有必要进行更大规模的进一步研究来验证这些发现。

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来源期刊

Cancer Management and Research Medicine-Oncology

CiteScore

7.40

自引率

0.00%

发文量

448

审稿时长

16 weeks

期刊介绍： Cancer Management and Research is an international, peer reviewed, open access journal focusing on cancer research and the optimal use of preventative and integrated treatment interventions to achieve improved outcomes, enhanced survival, and quality of life for cancer patients. Specific topics covered in the journal include: ◦Epidemiology, detection and screening ◦Cellular research and biomarkers ◦Identification of biotargets and agents with novel mechanisms of action ◦Optimal clinical use of existing anticancer agents, including combination therapies ◦Radiation and surgery ◦Palliative care ◦Patient adherence, quality of life, satisfaction The journal welcomes submitted papers covering original research, basic science, clinical & epidemiological studies, reviews & evaluations, guidelines, expert opinion and commentary, and case series that shed novel insights on a disease or disease subtype.