Lactate dehydrogenase/albumin ratio predicts progression of disease within 24 months (POD24) in advanced-stage extranodal natural killer/T cell lymphoma

Extranodal natural killer/T-cell lymphoma (ENKTL) is an aggressive malignancy with poor outcomes in advanced-stage disease. Although progression of disease within 24 months (POD24) serves as a powerful predictor of poor survival in various lymphoma subtypes, its utility in advanced-stage ENKTL has not been specifically validated. This study aims to identify high-risk patients with advanced-stage ENKTL and determine the clinical factors associated with early recurrence following anti-tumor treatment. We retrospectively analyzed 119 patients with advanced-stage ENKTL. All patients received asparaginase-based chemotherapy. Of the 119 patients, 81 patients (68.1%) experienced POD24. The 5-year overall survival (OS) rate was 36.0% for the entire cohort. Patients with POD24 had significantly worse outcomes compared to non-POD24 patients (5-year OS: 10.6% vs. 81.4%; p < 0.001). The optimal thresholds for serum albumin (ALB) and lactate dehydrogenase (LDH) levels were identified as 35.5 g/Land 264 u/L, respectively, and 6.0 for lactate dehydrogenase/albumin ratio (LAR). The result identified Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2, LDH >264 u/L, ALB <35.5 g/L, LAR >6.0, lymphocyte count <1.0×10⁹/L, and platelet count <75×10⁹/L as significant risk factors for POD24. In the subgroup with available Epstein-Barr virus (EBV)-DNA data (n=85), LAR >6.0 remained significantly associated with POD24. POD24 occurs in approximately two-thirds of advanced-stage ENKTL patients and serves as a critical marker for poor prognosis. Baseline LAR >6.0 is a readily available biomarker for predicting POD24, independent of EBV-DNA status. These findings facilitate early risk stratification and may guide treatment intensification strategies in this population.