Simple but powerful prognostic scoring model for MALT lymphoma: a retrospective study.
Simple but powerful prognostic scoring model for MALT lymphoma: a retrospective study.
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MALT 淋巴瘤简单但强大的预后评分模型：一项回顾性研究。
DOI：
10.1007/s00277-012-1585-0
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发表时间：
2013
期刊：
影响因子：
3.5
通讯作者：
Kurokawa M.
中科院分区：
文献类型：
--
作者：
Morita K;Nannya Y;Yoshizato T;Kurokawa M.
我们回顾了1997年2月至2010年4月在东京大学医院接受治疗的MALT淋巴瘤患者。这项研究包括那些在最初出现症状时接受了广泛的调查以进行准确分期，并在最初治疗后至少有24个月的临床随访数据的患者。临床变量对生存率的影响采用对数等级检验(单因素分析)，相关因素(P<；0.10)采用COX比例风险模型进行多因素分析。参数选择采用Akaike的信息标准进行优化。采用对数等级检验对不同组别患者进行比较。我们确定了53名符合纳入标准的患者。诊断时这些患者的特征如图1a所示。39例患者完全缓解，11例复发。中位总生存期(OS)为60个月(5~148个月)，无进展生存期(PFS)为42个月(1~131个月)，无病生存期(DFS)为56个月(6~128个月)。单变量分析发现低水平的血红蛋白(<；120g/L)(P00。0024)，LDH水平异常(P00.007)，更高的ECOG绩效状态评分(P00.021)、外周淋巴结转移(P00.046)；低血红蛋白水平(P00.067)，sIL-2R水平异常(P00.018)、外周淋巴结转移(P00.034)，根据Ann Arbor分类较高的临床分期(P00。007)用于PFS。临床分期较高(P<0.05)。我们对PFS进行了多因素分析，因为PFS是MALT淋巴瘤治疗效果的最重要的标志之一。因为治疗开始时的Ann Arbor分期和血红蛋白水平被显示为不良PFS的独立预后因素(P00。007和P00。041；危险比，3.58和2.97)，我们创建了一个简单的PFS评分模型，为这两个因素各分配一分，并根据总分将患者分成三组。该模型成功地将患者分为三组，每组具有不同的PFS(P00.004)(图1B)。该模型也适用于DFS(P<；0.001)(图1C)，但不适用于OS(P00.063)。
We reviewed the patients with MALT lymphoma treated at The University of Tokyo Hospital between February 1997 and April 2010. Patients who had undergone extensive survey for precise staging at initial presentation and with clinical follow-up data for at least 24 months after initial therapy were included in this study. Impact of clinical variables on survival was assessed using the log-rank test (in univariate analyses), and the factors showing relevant association (P< 0.10) were subjected to the multivariate analysis with Cox proportional hazard model. Parameter selection was optimized with Akaike’s information criteria. The log-rank test was used to compare different groups of patients. We identified 53 patients eligible to the inclusion criteria. The characteristics of these patients at diagnosis are summarized in Fig. 1a. Thirty-nine patients achieved complete remission, while relapse was seen in 11 patients. Median overall survival (OS; time from histological diagnosis to death from any causes), progression free survival (PFS; time from initial treatment to the date of first progression), and disease-free survival (DFS; time from first confirmation of CR after therapy to the day of losing CR) were 60 months (range 5–148 months), 42 months (range 1–131 months), and 56 months (range 6–128 months), respectively. Univariate analyses identified low hemoglobin level (< 120 g/L)(P00. 0024), abnormal LDH level (P00. 007), higher ECOG performance status scoring (P00. 021), and peripheral lymph node involvement (P00. 046) as possible contributing factors for OS; low hemoglobin level (P00. 067), abnormal sIL-2R level (P00. 018), peripheral lymph nodes involvement (P00. 034), and higher clinical stage according to the Ann Arbor classification (P00. 007) for PFS. Only higher clinical stage (P00. 008) affected DFS.We conducted the multivariate analysis for PFS because PFS is one of the most important markers for treatment efficacy for MALT lymphoma. Because the Ann Arbor staging and hemoglobin level at the initiation of treatment were revealed as independent prognostic factors on poor PFS (P00. 007 and P00. 041; hazard ratio, 3.58 and 2.97), we created a simple scoring model for PFS by allocating one point each for these two factors and stratifying patients to three groups according to the total score. This model successfully classified patients into three groups with different PFS (P00. 004)(Fig. 1b). This model was also valid for DFS (P< 0.001)(Fig. 1c) but not for OS (P00. 063).