Jun Cai1,2, Xiaopeng Tian1,2, Shuyun Ma1,2, Liye Zhong3, Wenyu Li4, Liang Wang5, Linlang Guo6, Zhihua Li7, Yudan Wu7, Guangzheng Zhong8, Huiqiang Huang1,2, Zhongjun Xia1,9, Yi Xia1,2, Panpan Liu1,2, Ning Su1,2, Yu Fang1,2, Yuchen Zhang1,2, Qingqing Cai10,11. 1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China. 2. Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China. 3. Department of Hematology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, P. R. China. 4. Lymphoma Division, Cancer Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, P. R. China. 5. Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, P. R. China. 6. Department of Pathology, Zhujiang Hospital, Southern Medical University, Guangzhou, P. R. China. 7. Department of Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China. 8. Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China. 9. Department of Hematology Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China. 10. State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China. caiqq@sysucc.org.cn. 11. Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China. caiqq@sysucc.org.cn.
Abstract
BACKGROUND: We aimed to establish a predictive prognostic risk-stratification model for diffuse large B-cell lymphoma (DLBCL) in the rituximab era. METHODS: The data of 1406 primary DLBCL patients from the Sun Yat-Sen University Cancer Center were analysed to establish a nomogram prognostic index (NPI) model for predicting overall survival (OS) based on pre-treatment indicators. An independent cohort of 954 DLBCL patients from three other hospitals was used for external validation. RESULTS: Age, performance status, stage, lactate dehydrogenase, number of extranodal sites, BCL2, CD5 expression, B symptoms and absolute lymphocyte and monocyte count were the main factors of the NPI model and could stratify the patients into four distinct categories based on their predicted OS. The calibration curve demonstrated satisfactory agreement between the predicted and actual 5-year OS of the patients. The concordance index of the NPI model (0.794) was higher than the IPI (0.759) and NCCN-IPI (0.750), and similar results were obtained upon external validation. For CD5 + DLBCL patients, systemic treatment with high-dose methotrexate was associated with superior OS compared to R-CHOP-based immunochemotherapy alone. CONCLUSIONS: We established and validated an accurate prediction model, which performed better than IPI and NCCN-IPI for prognostic stratification of DLBCL patients.
BACKGROUND: We aimed to establish a predictive prognostic risk-stratification model for diffuse large B-cell lymphoma (DLBCL) in the rituximab era. METHODS: The data of 1406 primary DLBCL patients from the Sun Yat-Sen University Cancer Center were analysed to establish a nomogram prognostic index (NPI) model for predicting overall survival (OS) based on pre-treatment indicators. An independent cohort of 954 DLBCL patients from three other hospitals was used for external validation. RESULTS: Age, performance status, stage, lactate dehydrogenase, number of extranodal sites, BCL2, CD5 expression, B symptoms and absolute lymphocyte and monocyte count were the main factors of the NPI model and could stratify the patients into four distinct categories based on their predicted OS. The calibration curve demonstrated satisfactory agreement between the predicted and actual 5-year OS of the patients. The concordance index of the NPI model (0.794) was higher than the IPI (0.759) and NCCN-IPI (0.750), and similar results were obtained upon external validation. For CD5 + DLBCL patients, systemic treatment with high-dose methotrexate was associated with superior OS compared to R-CHOP-based immunochemotherapy alone. CONCLUSIONS: We established and validated an accurate prediction model, which performed better than IPI and NCCN-IPI for prognostic stratification of DLBCL patients.
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