Prognostic application regarding PILE score and the pan-immune-inflammation value in diffuse large B-Cell Lymphoma.

Abstract

OBJECTIVE: This research explored the pan-immune-inflammation value (PIV) as prognostic significance factors in patients with diffuse large B-cell lymphoma (DLBCL). And we examined the PILE score, a composite parameter derived from lactate dehydrogenase (LDH), and Eastern Cooperative Oncology Group performance status (ECOG PS) and PIV as well. The findings were intended to contribute to more reliable prognostic assessment in clinical settings. METHODS: We retrospectively analyzed 90 patients diagnosed with DLBCL who accepted standard therapy consisting of a CD20 monoclonal antibody combined with the CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone),with appropriate dose or cycle adjustments made according to age, cardiac function, and performance status.Specifically, CD20 monoclonal antibody was administered at 375 mg/m2 on day 0 of each 21-day cycle. CHOP consisted of cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2 (reduced to 30–40 mg/m2 in patients ≥70 years or with cardiac dysfunction), vincristine 1.4 mg/m2 on day 1, and prednisone 100 mg/m2 on days 1–5. Most patients received 6 cycles, while those with high-risk features received 8 cycles.A total of 16 patients with bulky disease, high-risk extranodal involvement, or suboptimal response to first-line chemotherapy as assessed by PET-CT received chemotherapy combined with radiotherapy.The PIV was established by integrating quantitative data on platelets, lymphocytes, monocytes and neutrophils obtained from routine peripheral blood tests. The PILE score was subsequently determined by integrating PIV with ECOG PS and LDH levels. Associations of PIV and PILE scores with treatment outcomes and prognosis were examined, and their potential relationships with pathological tumor characteristics were also evaluated. RESULTS: Elevated PIV was independently correlated with poorer overall survival (OS) (hazard ratio (HR) = 3.79; 95% confidence interval (CI): 1.31–10.97; p = 0.0135), PIV was statistically significant in univariate analysis for PFS (P<0.001), making it the most robust prognostic marker among all assessed immune-inflammatory indices. Similarly, patients exhibiting higher PILE scores experienced significantly reduced progression-free survival (PFS) and OS (p < 0.01, respectively). We evaluated the association of PIV, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and PILE with treatment outcomes by conducting both univariable Cox regression and multivariable logistic regression analyses, defining treatment response as the measured endpoint. While all markers showed significant association with the outcome in univariable analyses (p < 0.01, respectively) at statistical level, none demonstrated independent predictive capacity in multivariable models. Among DLBCL patients, the PIV demonstrated an independent prognostic significance for OS outcomes. Furthermore, the PILE score, along with other systemic immune-inflammatory markers, demonstrated potential utility in forecasting treatment outcome or response.