Purpose: This study aimed to develop a prognostic nomogram in diffuse large B-cell lymphoma (DLBCL) and compare it with traditional prognostic systems.
Materials and methods: We included 1,070 consecutive and nonselected patients with DLBCL in the National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, between 2006 and 2012. A nomogram based on the Cox proportional hazards model was developed.
Results: The entire group were divided into the primary (n = 748) and validation (n = 322) cohorts. The 5-year overall survival (OS) rate was 64.1% for the entire group. Based on a multivariate analysis of the primary cohort, seven independent prognostic factors including age, Ann Arbor stage, Eastern Cooperative Oncology Group performance status score, lactate dehydrogenase, β2-microglobulin, CD5 expression, and Ki-67 index were identified and entered the nomogram. The calibration curve showed the optimal agreement between nomogram prediction and actual observation. In addition, the concordance index (C-index) of the nomogram for OS prediction was 0.77 (95% confidence interval [CI], 0.73-0.81) in the primary cohort and 0.76 (95% CI, 0.70-0.81) in the validation, superior to that of the international prognostic index (IPI), revised IPI (R-IPI), and National Comprehensive Cancer Network (NCCN)-IPI (range, 0.69-0.74, p<.0001). Moreover, in patients receiving rituximab plus CHOP (R-CHOP) or R-CHOP-like regimens, compared with IPI (C-index, 0.73; 95% CI, 0.69-0.77), R-IPI (C-index, 0.70; 95% CI, 0.66-0.74), or NCCN-IPI (C-index, 0.71; 95% CI, 0.66-0.75), the DLBCL-specific nomogram showed a better discrimination capability (p < .0001).
Conclusions: The proposed nomogram provided an accurate estimate of survival of patients with DLBCL, especially for those receiving R-CHOP or R-CHOP-like regimens, allowing clinicians to optimized treatment plan based on individualized risk prediction.
Implications for practice: A diffuse large B-cell lymphoma (DLBCL)-specific prognostic nomogram was developed based on Chinese patients with DLBCL. As a tertiary hospital, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences is the number 1 ranked cancer center in China, with more than 800,000 outpatients in 2018. Patients included in this study were nonselected and came from 29 different provinces, municipalities, and autonomous regions in China. Thus, the data is believed to be representative to an extent.
摘要
目的。本研究旨在构建弥漫性大 B 细胞淋巴瘤 (DLBCL) 的预后列线图，并与传统预后系统进行对比。
材料和方法。2006 年至 2012 年期间，我们在中国医学科学院国家癌症中心/国家癌症临床研究中心/肿瘤医院连续、非选择性纳入了 1 070 例 DLBCL 患者。我们建立了基于 Cox 比例风险模型的列线图。
结果。整个人群分为主要队列 (n = 748) 和验证队列 (n = 322)。整个人群的 5 年总生存率 (OS) 为 64.1%。对主要队列进行多变量分析，发现七个独立预后因素，包括年龄、Ann Arbor 分期、美国东部肿瘤协作组行为状态得分、乳酸脱氢酶、β2‐微球蛋白、CD5 表达和 Ki‐67 指数，并将这七个因素输入列线图。标定曲线与实测结果吻合较好。此外，主要队列的 OS 预测列线图一致性指数(C 指数)为 0.77[95% 可信区间 (CI)，0.73‐0.81]，验证队列组为 0.76 (95% CI, 0.70‐0.81)，优于国际预后指数 (IPI)、修订 IPI (R‐IPI) 和国家综合癌症网络(NCCN)‐IPI(范围 0.69‐0.74，p<0.000 1)。此外，在接受利妥昔单抗联合 CHOP (R‐CHOP) 或R‐CHOP 类方案的患者中，与 IPI(C 指数，0.73; 95% CI, 0.69‐0.77)、R‐IPI(C 指数，0.70; 95% CI, 0.66‐0.74) 或 NCCN‐IPI(C 指数，0.71; 95% CI, 0.66‐0.75)相比，DLBCL 的特异性列线图区分度较好 (p<0.000 1)。
结论。对于 DLBCL 患者，特别是对于接受 R‐CHOP 或 R‐CHOP 类方案的患者，本文所构建的列线图能够准确估计其生存情况，临床医生能够基于个体化风险预测来优化治疗方案。《肿瘤学家》(The Oncologist)2019;24:1–10
实践意义:以中国弥漫性大 B 细胞淋巴瘤 (DLBCL) 患者作为研究基础，构建了 DLBCL 特异性预后列线图。作为三级医院，中国医学科学院国家癌症中心/肿瘤医院是中国排名第一的癌症中心，2018 年门诊患者超过 80 万人次。本研究纳入的患者均为来自中国 29 个省、市、自治区的非选择性患者。因此，可认为这些数据具有一定的代表性。
© AlphaMed Press 2019.