Prognostic performance of lymphocyte-to-monocyte ratio in diffuse large B-cell lymphoma: an updated meta-analysis of eleven reports

Advanced development of biomarkers for immunotherapy in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most common liver cancer and one of the leading causes of cancer-related deaths in the world. Mono-immunotherapy and combination therapy with immune checkpoint inhibitors (ICIs) and multitargeted tyrosine kinase inhibitors (TKIs) or anti-vascular endothelial growth factor (anti-VEGF) inhibitors have become new standard therapies in advanced HCC (aHCC). However, the clinical benefit of these treatments is still limited. Thus, proper biomarkers which can predict treatment response to immunotherapy to maximize clinical benefit while sparing unnecessary toxicity are urgently needed. Contrary to other malignancies, up until now, no acknowledged biomarkers are available to predict resistance or response to immunotherapy for HCC patients. Furthermore, biomarkers, which are established in other cancer types, such as programmed death ligand 1 (PD-L1) expression and tumor mutational burden (TMB), have no stable predictive effect in HCC. Thus, plenty of research focusing on biomarkers for HCC is under exploration. In this review, we summarize the predictive and prognostic biomarkers as well as the potential predictive mechanism in order to guide future research direction for biomarker exploration and clinical treatment options in HCC.

Prognostic value of prelymphodepletion absolute lymphocyte counts in relapsed/refractory diffuse large B-cell lymphoma patients treated with chimeric antigen receptor T cells

Introduction

Chimeric antigen receptor (CAR) T cell therapy has achieved unprecedented efficacy recently. However, the factors related to responses and durable remission are elusive. This study was to investigate the impact of pre-lymphodepletion (pre-LD) absolute lymphocyte count (ALC) on CAR T cell therapy outcomes.

Methods

We conducted a retrospective study of 84 patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) who underwent CAR T cell treatment at the Affiliated Hospital of Xuzhou Medical University between March 1,2016 and December 31, 2021. The enrolled patients were divided into high group and low group according to the optimal cutoff value of pre-LD ALC. The Kaplan-Meier analyses was used to calculate survival curves. The Cox proportional hazards model was used for univariate and multivariate analysis to assess the prognostic factors.

Results

The ROC showed that the optimal cutoff value of pre-LD ALC was 1.05 x 10⁹/L. The overall response (defined as partial response or complete response) rate was significantly higher in patients with a high pre-LD ALC (75% versus 52.08%; P=0.032). Patients with a low pre-LD ALC had significantly inferior overall survival (OS) and progression-free survival (PFS) compared with those having a high pre-LD ALC (median OS, 9.6 months versus 45.17 months [P=0.008]; median PFS, 4.07 months versus 45.17 months [P= 0.030]). Meanwhile, low pre-LD ALC is an independent risk factor for PFS and OS.

Discussion

The data suggested that pre-LD ALC may serve as a helpful indicator to predict the outcomes of CAR T cell therapy in patients with R/R DLBCL.

Neutrophils as potential therapeutic targets in hepatocellular carcinoma

The success of atezolizumab plus bevacizumab treatment contributed to a shift in systemic therapies for hepatocellular carcinoma (HCC) towards combinations that include cancer immunotherapeutic agents. Thus far, the principal focus of cancer immunotherapy has been on interrupting immune checkpoints that suppress antitumour lymphocytes. As well as lymphocytes, the HCC environment includes numerous other immune cell types, among which neutrophils are emerging as an important contributor to the pathogenesis of HCC. A growing body of evidence supports neutrophils as key mediators of the immunosuppressive environment in which some cancers develop, as well as drivers of tumour progression. If neutrophils have a similar role in HCC, approaches that target or manipulate neutrophils might have therapeutic benefits, potentially including sensitization of tumours to conventional immunotherapy. Several neutrophil-directed therapies for patients with HCC (and other cancers) are now entering clinical trials. This Review outlines the evidence in support of neutrophils as drivers of HCC and details their mechanistic roles in development, progression and metastasis, highlighting the reasons that neutrophils are well worth investigating despite the challenges associated with studying them. Neutrophil-modulating anticancer therapies entering clinical trials are also summarized.

Prognostic nutritional index and the prognosis of diffuse large b-cell lymphoma: a meta-analysis

Background

Some studies have investigated the prognostic value exhibited by the Prognostic Nutritional Index (PNI) in patients suffering diffuse large B-cell lymphoma (DLBCL), but varying results were obtained. In order to determine the specific prognostic value more accurately, a meta-analysis was conducted in this study.

Methods

Literatures were searched from the China National Knowledge Infrastructure (CNKI), Wanfang, PubMed, Embase, the Cochrane Library, and Web of Science. Pooled hazard ratio (HR) and the 95% confidence interval (CI) were calculated to assess the association between PNI and the overall survival (OS) and the progression-free survival (PFS) of patients with DLBCL.

Results

Based on seven studies with a total number of 1311 patients, our meta-analysis revealed that low PNI may meant poor OS (HR = 2.14, 95% CI 1.66-2.75, p < 0.001) and poor PFS (HR = 1.75, 95% CI 1.36-2.25, p = 0.438). Subgroup analysis showed that, in Asians, low PNI was correlated to poor OS (pooled HR = 2.06 95% CI 1.59-2.66) and poor PFS (pooled HR = 1.66, 95% CI 1.28-2.15). Similar results were obtained from one European study, which is the only study performed outside of Asia from our literature search.

Conclusion

For patients with DLBCL, low PNI may be interpreted as adverse prognosis. More data from European patients are required in this study to avoid analysis bias.

Diagnostic value of alpha-fetoprotein combined with neutrophil-to-lymphocyte ratio for hepatocellular carcinoma

BACKGROUND

To investigate the diagnostic performance of alpha-fetoprotein (AFP) and neutrophil-to-lymphocyte ratio (NLR) as well as their combinations with other markers.

METHODS

Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), AFP and levels as well as the numbers of neutrophils and lymphocytes of all enrolled patients were collected. The NLR was calculated by dividing the number of neutrophils by the number of lymphocytes. Receiver operating characteristic (ROC) curve analysis was conducted to determine the ability of each marker and combination of markers to distinguish HCC and liver disease patients.

RESULTS

In total, 545 patients were included in this study. The area under the ROC curve (AUC) values for AFP, ALT, AST, and NLR were 0.775 (0.738-0.810), 0.504 (0.461-0.547), 0.660 (0.618-0.699), and 0.738 (0.699-0.774) with optimal cut-off values of 24.6 ng/mL, 111 IU/mL, 27 IU/mL, and 2.979, respectively. Of the four biomarkers, AFP and NLR showed comparable specificity (0.881 and 0.858) and sensitivity (0.561 and 0.539). The combination of AFP and NLR showed the highest AUC (0.769) with a significantly higher sensitivity (0.767) and a lower specificity (0.773) compared to AFP or NLR alone, and it had the highest sum of sensitivity and specificity (1.54) among all combinations. In patients with AFP < 20 ng/mL, the NLR showed the highest AUC and combination with other markers did not improve the diagnostic accuracy.

CONCLUSIONS

Our data indicate that the combination of AFP and NLR offers better diagnostic performance than either marker alone for differentiating HCC from liver disease, which may benefit clinical screening.

Lymphocyte-monocyte ratio at day 14 of first cisplatin-doxorubicin chemotherapy is associated with treatment outcome of pediatric patients with localized osteosarcoma

Purpose

We aimed to determine the prognostic significance of lymphocyte counts and the lymphocytemonocyte ratio (LMR) in pediatric patients with osteosarcoma.

Methods

We retrospectively reviewed the medical records of 27 pediatric patients with localized extremity osteosarcoma, treated at the Korea Cancer Center Hospital between May 2002 and March 2016. Leukocyte counts and LMR before treatment and on day 14 (LMR14) of the first cisplatin-doxorubicin chemotherapy round were evaluated. Patients were dichotomized according to the median value of these parameters, and survival rates were compared.

Results

The median age of the 27 patients was 9.9 years (range, 3.2–14.1 years) and tumor sites were: distal femur (n=14), proximal humerus (n=7), proximal tibia (n=2), proximal fibula (n=2), and elsewhere (n=2). Patients were followed up on for a median of 76.4 months (range, 4.5–174.7 months), and 5-year overall (OS) and event-free survival (EFS) rates were 66.0%±9.8% and 60.9%±9.7%, respectively. Patients with a higher pretreatment lymphocyte count (≥2,320/μL) had better OS (90.9% vs. 46.2%, P=0.04) and EFS (83.9% vs. 38.5%, P=0.02). However, the day 14 lymphocyte count was not associated with survival. While no survival difference was observed between patients grouped according to pretreatment LMR (median value, 6.3), patients with a higher LMR14 (≥5) fared better than those with lower LMR14 (5-year OS: 83.3% vs. 46.3%, P=0.04).

Conclusion

Pretreatment lymphocyte count and LMR during chemotherapy had prognostic significance in pediatric osteosarcoma patients. Further studies involving larger cohorts are necessary to validate our findings.

B cell lymphoma progression promotes the accumulation of circulating Ly6Clo monocytes with immunosuppressive activity

Monocytosis is considered a poor prognostic factor for many cancers, including B cell lymphomas. The mechanisms by which different monocyte subsets support the growth of lymphoma is poorly understood. Using a pre-clinical mouse model of B cell non-Hodgkin's lymphoma (B-NHL), we investigated the impact of tumor progression on circulating monocyte levels, subset distribution and their activity, with a focus on immune suppression. B-NHL development corresponded with significant expansion initially of classical (Ly6Chi) and non-classical (Ly6Clo) monocytes, with accumulation and eventual predominance of Ly6Clo cells. The lymphoma environment promoted the conversion, preferential survival and immune suppressive activity of Ly6Clo monocytes. Ly6Clo monocytes expressed higher levels of immunosuppressive genes including PD-L1/2, Arg1, IDO1 and CD163, compared to Ly6Chi monocytes. Both monocyte subsets suppressed CD8 T cell proliferation and IFN-γ production in vitro, but via different mechanisms. Ly6Chi monocyte suppression was contact dependent, while Ly6Clo monocytes suppressed via soluble mediators, including IDO and arginase. Ly6Clo monocytes could be selectively depleted in tumor-bearing hosts by liposomal doxorubicin treatment, further enhanced by co-administration of anti-4-1BB monoclonal antibody. This treatment led to a reduction in tumor growth, but failed to improve overall survival. Analogous immunosuppressive monocytes were observed in peripheral blood of diffuse large B cell lymphoma patients and actively suppressed human CD8 T cell proliferation. This study highlights a potential immune evasion strategy deployed by B cell lymphoma involving accumulation of circulating non-classical monocytes with immunosuppressive activity.

Prognostic role of the lymphocyte-to-monocyte ratio in colorectal cancer: An up-to-date meta-analysis

BACKGROUND

Although previous meta-analyses have proved that lymphocyte-to-monocyte ratio (LMR) is a prognostic factor in solid cancers, its prognostic role in colorectal cancer (CRC) remains controversial. We, therefore, conducted this up-to-date meta-analysis to evaluate the prognostic role of the LMR in CRC.

METHODS

A systematic search was performed in PubMed and Embase for relevant studies in November 2016. Article assessing the prognostic role of LMR in CRC was enrolled in this meta-analysis. Data and characteristics of each study were extracted. A meta-analysis was performed to generate pooled hazard ratio (HR) and 95% confidence intervals (95% CIs) for overall survival (OS) and disease-free survival. Begg funnel plot was used to evaluate publication bias.

RESULTS

Eleven studies published between 2014 and 2016 with a total of 9045 patients were enrolled in this meta-analysis. Our findings indicated that a low LMR predicted a worse OS (HR 1.57, 95% CI 1.30-1.90, P < .001) and disease-free survival. (HR 1.25, 95% CI 1.13-1.39, P < .001) for patients with CRC. Subgroup analyses according to stage (I-III and IV) and LMR cut-off value (<3.00 and ≥3.00) showed a significant prognostic value of LMR on OS. Begg funnel plot showed that publication bias existed in this meta-analysis.

CONCLUSIONS

This up-to-date meta-analysis shows that a low LMR is associated with poor survival in patients with CRC, although the publication bias is existed. Large-sample multicenter prospective cohort is needed to assess the role of the LMR in CRC patients.

Prognostic significance of neutrophil-to-lymphocyte ratio in diffuse large B-cell lymphoma: A meta-analysis

Background

Neutrophil-to-lymphocyte ratio (NLR) has been investigated as a prognostic marker in patients with diffuse large B-cell lymphoma (DLBCL); however, the results remain controversial. This study aimed to explore the association between NLR and survival outcomes and clinicopathological factors in DLBCL.

Methods

Relevant studies were retrieved by searching PubMed, Embase, Web of Science, and China National Knowledge Infrastructure (CNKI) databases. The last search was updated on February 17, 2017. Hazard ratios (HRs) and odds ratios (ORs) and their 95% confidence intervals (CIs) were used as effective measures in the meta-analysis. Random-effects models and fixed-effects models were used for analyses. Meta-regression was performed. Publication bias was assessed using Begg’s test. Stata version 12.0 was used for all analyses.

Results

A total of 9 studies with 2297 patients were included in the meta-analysis. The pooled results showed that NLR was a significant indicator for poor overall survival (OS) (HR = 1.84, 95% CI = 1.52–2.22, p<0.001) and poor progression-free survival (PFS) (HR = 1.64, 95% CI = 1.36–1.98, p<0.001). NLR remained a significant biomarker for OS and PFS regardless of location, sample size or cut-off value. In addition, high NLR was also associated with Ann Arbor stage (OR = 2.09, 95% CI = 1.14–3.81, p = 0.017), lactate dehydrogenase level (OR = 2.74, 95% CI = 1.16–6.46, p = 0.021), extranodal disease (OR = 1.63, 95% CI = 1.06–2.52, p = 0.027), and International Prognostic Index score (OR = 2.44, 95% CI = 1.03–5.08, p = 0.043). However, NLR was found to have no significant association with sex (OR = 0.89, 95% CI = 0.71–1.11, p = 0.29), age (OR = 1.18, 95% CI = 0.94–1.48, p = 0.152), European Cooperative Oncology Group performance status score (OR = 1.78, 95% CI = 0.71–4.46, p = 0.217), or presence of B symptoms (OR = 1.56, 95% CI = 0.7–3.48, p = 0.278).

Conclusion

In conclusion, our meta-analysis demonstrated that NLR has a strong association with worse OS and PFS in patients with DLBCL. NLR could be recommended as an inexpensive prognostic biomarker in DLBCL.