Development and validation of a clinical prediction rule for bone marrow involvement in patients with Hodgkin lymphoma
Development and validation of a clinical prediction rule for bone marrow involvement in patients with Hodgkin lymphoma
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DOI：
10.1182/blood-2004-01-0379
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发表时间：
2005-03-01
期刊：
影响因子：
20.3
通讯作者：
Pangalis, GA
中科院分区：
文献类型：
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作者：
Vassilakopoulos, TP;Angelopoulou, MK;Pangalis, GA
我们在826例霍奇金淋巴瘤患者的基础上制定了一项骨髓受累(BMI)的临床预测规则，并在另外654名患者中进行了验证。影响体重指数的独立预后因素有：x(1)，B症状；x(2)，骨髓活检前III/IV期；x(3)，贫血；x(4)，白细胞<6×10(9)/L；x(5)，年龄35岁以上；x(6)，累及髂腹股沟。每个因素被评分为x(I)=1，如果存在，或者xi=0，如果不存在。每个患者的简化评分Z(S)=8x(1)+6x(2)+5x(3)+5x(4)+3x(5)+3x(6)-8。该预测规则的灵敏度为97.8%，特异度为51.5%，阳性预测值为10.6%，阴性预测值为99.8%。验证组分别为98.1%、40.3%、12.7%和99.6%。根据Z(S)值，定义了体重指数的3个危险组：低危(Z(S)和t；0，44%的患者，0.3%的风险)，标准风险(Zs，0~9；37%的患者，4.2%的风险)，高危(Z(S)大于或等于10，20%的患者，25.5%的风险)。低危患者(IA/IIA期无贫血和白细胞减少；IA/IIA期35岁以下，有贫血或白细胞减少但无腹股沟/Ilac受累；IIIA/IVA期无上述4种危险因素中的任何一种)不需要进行骨髓活检。标准风险的患者应该进行单侧活检，但高风险的患者可能受益于双侧活检。
We developed a clinical prediction rule for bone marrow involvement (BMI) in Hodgkin lymphoma based on 826 patients and validated it in 654 additional patients. Independent prognostic factors for BMI were x(1), B symptoms; x(2), stage III/IV prior to bone marrow biopsy; x(3), anemia; x(4), leukocytes fewer than 6 x 10(9)/L; x(5), age 35 years or older; and x(6), iliac/inguinal involvement. Each factor was graded as x(i) = 1, if present, or xi = 0, if absent. A simplified score Z(s) = 8x(1) + 6x(2) + 5x(3) + 5x(4) + 3x(5) + 3x(6) - 8 was assigned to each patient. The sensitivity, specificity, and positive and negative predictive value of this prediction rule was 97.8%, 51.5%, 10.6%, and 99.8%, respectively. In the validation group, they were 98.1%, 40.3%, 12.7%, and 99.6%. According to Z(s) value, 3 risk groups for BMI were defined: low risk (Z(s) < 0, 44% of patients, 0.3% risk), standard risk (Zs, 0-9; 37% of patients; 4.2% risk), and high risk (Z(s) greater than or equal to 10, 20% of patients, 25.5% risk). Patients with low risk (stage IA/IIA without anemia and leukopenia; stage IA/IIA, younger than 35 years, with either anemia or leukopenia but no inguinal/illac involvement; and stage IIIA/IVA without any of these 4 risk factors) do not need bone marrow (BM) biopsy. Patients with standard risk should be staged with unilateral biopsy, but patients with high risk may benefit from bilateral biopsy.