Objective To evaluate the clinical value of red cell volume distribution   width (RDW) to absolute lymphocyte count (ALC) ratio (RLR) in extranasal natural killer/T-cell lymphoma (ENKTL), and to provide information for better risk stratification.

Method  Clinical data of patients with ENKTL diagnosed in Zhongnan Hospital of Wuhan University from April 2013 to May 2022 were retrospectively analyzed. Kaplan-Meier curve and Cox proportional risk model were used to analyze the prognostic value of RLR. By integrating RLR, improved international prognostic index (IPI), Korean prognostic index (KPI), prognostic model of natural killer lymphoma (PINK) and nomogram-revision risk index (NRI) models were established respectively, and verified by subject operating characteristic curve.

Results  72 ENKTL patients were included. There were statistically significant differences in age, ECOG PS score, IPI score, NRI score, LDH level and B symptoms (P<0.05) in ENKTL patients with different RLR levels. The median follow-up time of this study was 43 months. The Kaplan-Meier curve showed that the 3-year PFS rate (50.6% vs. 28.8%, P=0.032) and the 3-year OS rate (79.2% vs. 40.8%, P=0.001) were significantly higher than those in the high RLR group (RLR≥10.2). Univariate analysis showed that RLR≥10.2 [HR=4.120, 95%CI (1.643, 10.333), P=0.003], ALC<1.0×10⁹/L [HR=3.793, 95%CI (1.712, 8.403), P= 0.001], RDW≥13.6 [HR=2.874, 95%CI (1.199, 6.886), P=0.018] were all related to poor prognosis of OS in patients with ENKTL. After adjusting the chemotherapy regimen (with or without asparaginase), multivariate analysis showed that ALC<1.0×10⁹/L [HR=3.146, 95%CI (1.249, 7.924), P=0.015] and RLR≥10.2[HR= 3.228, 95%CI (1.077, 9.680), P=0.036] were still significantly associated with poor prognosis of OS in patients with ENKTL; in Ann Arbor stage I~II patients, multivariate analysis showed that ALC<1.0×10⁹/ L [HR=3.970, 95%CI (1.173, 13.436), P=0.027], ECOG PS ≥ 2 points [HR=4.261, 95%CI (1.219, 14.900), P=0.023] were independent risks of OS in early patients factor. Stratified analysis showed that RLR contributed to risk stratification in patients with ENKTL. In addition, the integrated RLR provided additional prognostic information for the IPI, KPI, PINK and NRI models.

Conclusion ALC can be used as an indicator for evaluating the prognosis of patients with early ENKTL, and RLR may be helpful for risk stratification and clinical decision-making in patients with ENKTL.

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