The relationship between neutrophil-to-lymphocyte ratio and mid-term evaluation in patients with gastrointestinal Diffuse large B-cell lymphoma Free

Background: Diffuse large B - cell lymphoma (DLBCL) is the most common subtype of non - Hodgkin lymphoma. Approximately 30% - 40% of DLBCL cases involve the gastrointestinal tract, forming primary gastrointestinal DLBCL (PGI - DLBCL). DLBCL with gastrointestinal involvement has unique clinical features, such as higher invasiveness, and a prognostic pattern different from that of node - derived DLBCL. Mid - term efficacy evaluation is a key link in adjusting treatment strategies, but there is currently a lack of reliable biomarkers to assist in judging treatment responses. The neutrophil - to - lymphocyte ratio (NLR), as an indicator reflecting the balance between systemic inflammation and immunity, has been confirmed to be related to prognosis in various malignant tumors. On the one hand, mid - term treatment response is a strong predictor of prognosis; on the other hand, NLR may supplement the deficiency of imaging evaluation by reflecting the treatment - induced inflammatory state or immune suppression.

Methods: We conducted a retrospective analysis among patients with newly diagnosed diffuse large B - cell lymphoma (DLBCL) involving the gastrointestinal tract from 2022 to 2024. NLR was calculated using records from complete blood counts (CBC) of 107 newly diagnosed DLBCL patients. A higher NLR is associated with an increase in absolute neutrophil count, a decrease in lymphocyte count, and systemic inflammatory markers. Among the 82 patients who had mid - term evaluation, 73 patients responded to chemotherapy (mid - term evaluation was CR or PR), with NLR M (Q₁, Q₃) = 6.12 (3.58, 15.20), and 9 patients had no response, with NLR M (Q₁, Q₃) = 3.02 (2.23, 4.73). There was a significant difference between the two groups. Patients were divided into two groups according to the median baseline neutrophil-to-lymphocyte ratio (NLR), and there were significant differences between the two groups in terms of HGB, ALB, FIB, Na, Cl, β2-MG, LDH, HDL-C, and LDL-C. In the mid - term evaluation, for each 1 unit decrease in NLR, the risk of non - response events during mid - term treatment was reduced to 0.109 times the original (95% confidence interval [CI] 0.013 - 0.910, OR). After adjusting for covariates such as gender, age, BMI, albumin, hemoglobin, platelets, sodium ions,ECOG score,extranodal organ involvement, underlying diseases, whether it is double - expressor lymphoma, and treatment methods, the results showed that compared with individuals with lower NLR (≤3.49), individuals with higher NLR (>3.49) had a lower chemotherapy response rate (odds ratio OR 0.4, 95% confidence interval [CI] 0.002 - 0.981). The initial NLR level at diagnosis was negatively correlated with the mid - term chemotherapy response rate in patients with gastrointestinal DLBCL.

Conclusion: This conclusion further verifies that in clinical evaluation, the mid - term efficacy of chemotherapy can be judged based on the baseline level of NLR at admission. It is expected to establish a mid - term evaluation model with NLR as the core, make up for the deficiency of existing prognostic tools (such as IPI score) in dynamic evaluation, and promote the precise management of gastrointestinal DLBCL.