Significance of preoperative peripheral blood neutrophil-lymphocyte ratio in predicting postoperative survival in patients with multiple myeloma bone disease

Table 1 General information of the 82 multiple myeloma bone disease patients who underwent surgical treatments

Characteristic	Value n (%) or n [SD]
Age (yr)	60.33 [9.620]
Gender
Male	44 (53.7)
Female	38 (46.3)
ISS stage
ISS-I	15 (18.3)
ISS-II	37 (45.1)
ISS-III	30 (36.6)
Number of lesions
1	53 (64.6)
2	18 (22.0)
≥ 3	11 (13.4)
Site of lesion
Spine	56 (68.3)
Long bone of limb	19 (23.2)
Soft tissue	7 (8.5)
Isotype
IgA	23 (28)
IgD	3 (3.7)
IgG	45 (54.9)
Light chain κ/λ	11 (13.4)
Preoperative chemotherapy
Yes	48 (58.5)
No	34 (41.5)
Postoperative chemotherapy
Yes	71 (86.6)
No	11 (13.4)
Preoperative radiotherapy
Yes	6 (7.3)
No	76 (92.7)
Time from a diagnosis to surgery (mo)	19.48 [26.69]
Operation scheme
Complete excision1	9 (11)
Partial excision/intramedullary curettage2	72 (87.8)
Tissue biopsy3	1 (1.2)
Autologous stem cell transplantation
Yes	20 (24.4)
No	62 (75.6)
POS (mo)	27.03 [21.31]
Total survival (mo)	46.63 [31.04]

¹The soft-tissue mass extended resection or partial rib resection.

²Intralesional resection and filling with polymethylmethacrylate bone cement in long bone of limb metastases or incomplete mastectomy in spinal metastases.

³Percutaneous biopsy.

SD: Standard deviation; ISS: International staging system; POS: Postoperative survival.

Table 2 General physical condition of 82 multiple myeloma bone disease patients before surgical treatments

Characteristic	Value n (%) or n [SD]
Preoperative nutrition
Well	68 (82.9)
Fairly	6 (7.3)
Poorly	8 (9.8)
Preoperative BMI (kg/m2)	23.14 [3.36]
Preoperative performance status
Grade 0-2	16 (19.5)
Grade 3-4	66 (80.5)
Preoperative MM activity
Partial remission	2 (2.4)
Stable disease	8 (9.8)
Progression disease	72 (87.8)

SD: Standard deviation; BMI: Body mass index; MM: Multiple myeloma.

Table 3 Comparison of 1-year, 3-year and 5-year cumulative survival rates between the high and the low neutrophil-lymphocyte ratio group

Cutoff value of NLR	1-yr CSRa	3-yr CSRa	5-yr CSRa	Chi-square	P value
NLR ≥ 4	41.7% vs 82.5%	10.4% vs 60.9%	0.0% vs 41.7%	15.969	0.000a
NLR ≥ 3 (n = 26)	52.0% vs 87.3%	19.1% vs 67.2%	0.0% vs 48.3%	22.192	0.000a
NLR ≥ 2	65.8% vs 88.9%	46.5% vs 61.1%	31.0% vs 34.0%	2.015	0.156
NLR ≥ 1	75.3% vs 85.7%	52.6% vs -	30.6% vs -	0.459	0.498

^aP < 0.05.

NLR: Neutrophil-lymphocyte ratio; CSR: Cumulative survival rates.

Table 4 Univariate analysis of the general information of patients in the high and the low neutrophil-lymphocyte ratio group

Characteristic	NLR < 3 (n = 56)	NLR ≥ 3 (n = 26)	P value
Age (yr)	60.93 ± 9.88	59.04 ± 9.10	0.411
Gender, n (%)			0.981
Male	30 (53.6)	14 (53.8)
Female	26 (46.4)	12 (46.2)
ISS stage, n (%)			0.693
ISS-I	10 (17.9)	5 (19.2)
ISS-II	27 (48.2)	10 (38.5)
ISS-III	19 (33.9)	11 (42.3)
Number of lesions, n (%)			0.033a
1	41 (73.2)	12 (46.2)
2	8 (14.3)	10 (38.5)
≥ 3	7 (12.5)	4 (15.4)
Site of lesion, n (%)			0.982
Spine	38 (67.9)	18 (69.2)
Long bone of limb	13 (23.2)	6 (23.1)
Soft tissue	5 (8.9)	2 (7.7)
Time from a diagnosis to surgery (mo)	21.18 ± 29.75	15.81 ± 18.44	0.321
Preoperative nutrition, n (%)			0.071
Well	50 (89.3)	18 (69.2)
Fairly	3 (5.4)	3 (11.5)
Poorly	3 (5.4)	5 (19.2)
Preoperative BMI (kg/m2)	23.80 ± 3.29	21.74 ± 3.13	0.009a
Preoperative performance status, n (%)			0.066
Grade 0-2	14 (25.0)	2 (7.7)
Grade 3-4	42 (75.0)	24 (92.3)
MM activity at the time of surgery, n (%)			0.590
Partial response	2 (3.6)	0 (0.0)
Stable disease	5 (8.9)	3 (11.5)
Progressive disease	49 (87.5)	23 (88.5)
Preoperative chemotherapy, n (%)			0.707
Yes	32 (57.1)	16 (61.5)
No	24 (42.9)	10 (38.5)
Preoperative chemotherapy regimens (n = 48), n (%)			0.216
Immunomodulator-based	6 (37.5)	5 (15.6)
Proteasome inhibitor-based	6 (37.5)	14 (43.8)
Both immunomodulator and proteasome inhibitor	4 (25.0)	13 (40.6)
Postoperative chemotherapy, n (%)			0.080
Yes	51 (91.1)	20 (76.9)
No	5 (8.9)	6 (23.1)
Postoperative chemotherapy regimens (n = 71), n (%)			0.159
Immunomodulator-based	3 (6.0)	4 (19.0)
Proteasome inhibitor-based	17 (34.0)	4 (19.0)
Both immunomodulator and proteasome inhibitor	30 (60.0)	13 (61.9)
Autologous stem cell transplantation, n (%)			0.458
Yes	15 (26.8)	5 (19.2)
No	41 (73.2)	21 (80.8)
POS (mo)	32.68 ± 21.76	14.86 ± 14.28	0.001

^aP < 0.05.

NLR: Neutrophil-lymphocyte ratio; POS: Postoperative survival; ISS: International staging system; BMI: Body mass index; MM: Multiple myeloma.

Table 5 Univariate analysis of the preoperative laboratory examination of patients in the high and the low neutrophil-lymphocyte ratio group

Preoperative laboratory examination	NLR < 3 (n = 56)	NLR ≥ 3 (n = 26)	P value
Hb (g/L)	112.66 ± 24.88	100.58 ± 25.91	0.047a
PLT (109/L)a	208.38 ± 77.39	196.89 ± 103.64	0.577
ALb (g/L)	32.88 ± 6.02	31.16 ± 6.29	0.237
AST (U/L)	22.89 ± 8.39	33.96 ± 18.79	0.007a
ALT (U/L)	19.89 ± 10.28	28.46 ± 24.17	0.093
Γ-GT (U/L)	34.11 ± 27.52	47.58 ± 38.19	0.073
Blood β2-MG (mg/L)	5.43 ± 9.08	4.10 ± 2.85	0.475
Cr (umol/L)	84.54 ± 73.73	89.38 ± 85.84	0.794
Preoperative CRP (mg/L)	2.60 ± 3.84	3.67 ± 3.93	0.411
Post-operative CRP (mg/L)	1.98 ± 2.79	1.83 ± 2.06	0.877

^aP < 0.05.

NLR: Neutrophil-lymphocyte ratio; CPR: C-reactive protein; AST: Aspartate aminotransferase; Hb: Hemoglobin; Alb: Albumin; ALT: Alanine transaminase; Γ-GT: Glutamyl transpeptidase; Cr: Creatinine.

Table 6 One-way ANOVA results of peripheral blood absolute lymphocyte counts, absolute neutrophil counts and neutrophil-lymphocyte ratio of the 82 multiple myeloma bone disease patients at different time points (mean ± SD)

Characteristic	Before operation	1 wk after operation	1 mo after operation	Last follow-up visit	F	P value
Absolute blood lymphocyte counts	1.34 ± 0.75	1.19 ± 0.55	1.45 ± 0.76	1.15 ± 0.821,2	2.382	0.070
Absolute neutrophil counts	3.87 ± 2.07	4.79 ± 2.373-5	3.72 ± 1.96	3.36 ± 2.04	4.376	0.005
NLR	2.78 ± 1.976,7	4.56 ± 2.33	3.14 ± 2.198	5.03 ± 6.73	4.998	0.002
Lymphocyte percentages (%)	25.09 ± 9.96	18.19 ± 7.193,4	26.66 ± 10.70	22.83 ± 12.68	5.770	0.001

¹When that at the last follow-up visit was compared to that 1 wk after operation, P = 0.055.

²When that at the last follow-up visit was compared to that 1 wk after operation, P < 0.05.

³When that 1 wk after operation was compared to that before operation, P < 0.05.

⁴When that 1 wk after operation was compared to that 1 mo after operation, P < 0.05.

⁵When that 1 wk after operation was compared to that at the last follow-up visit, P < 0.05.

⁶When that before operation was compared to that 1 wk after operation, P < 0.05.

⁷When that before operation was compared to that at the last follow-up visit, P < 0.05.

⁸When that 1 mo after operation was compared to that at the last follow-up visit, P < 0.05.

NLR: Neutrophil-lymphocyte ratio.

Table 7 Kaplan–Meier analysis of postoperative survival of patients with multiple myeloma bone disease (univariate survival analysis)

Characteristic	Chi-square	P value
Gender	1.703	0.192
ISS stage	1.966	0.374
Number of lesions	7.055	0.029a
Site of lesion	8.160	0.017a
Isotype	1.526	0.676
Preoperative chemotherapy	0.387	0.534
Postoperative chemotherapy	35.837	0.000a
Preoperative radiotherapy	0.908	0.341
Time from a diagnosis to surgery	1.841	0.606
Operation scheme	3.583	0.167
Stem cell transplantation	2.836	0.092
Preoperative peripheral blood NLR ≥ 3	22.192	0.000a
Preoperative nutrition	0.782	0.676
Preoperative performance status	20.775	0.000a
Preoperative MM activity	1.634	0.652

^aP < 0.05.

NLR: Neutrophil-lymphocyte ratio; ISS: International staging system; MM: Multiple myeloma.

Table 8 Multivariate Cox regression analysis of postoperative survival of patients with multiple myeloma bone disease

Characteristic	P value	HR	95% CI
Site of lesion	0.185	-	-
Number of lesions	0.462	-	-
Postoperative chemotherapy	0.000a	0.142	0.057-0.357
Preoperative peripheral blood NLR ≥ 3	0.000a	3.503	1.815-6760
Preoperative performance status	0.002a	0.041	0.005-0.318

^aP < 0.05.

NLR: Neutrophil-lymphocyte ratio.