Validation of the NCCN-IPI for diffuse large B-cell lymphoma (DLBCL): the addition of β2-microglobulin yields a more accurate GELTAMO-IPI
Validation of the NCCN-IPI for diffuse large B-cell lymphoma (DLBCL): the addition of β2-microglobulin yields a more accurate GELTAMO-IPI
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DOI：
10.1111/bjh.14489
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发表时间：
2017-03-01
影响因子：
6.5
通讯作者：
Garcia, Juan F.
中科院分区：
文献类型：
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作者：
Montalban, Carlos;Diaz-Lopez, Antonio;Garcia, Juan F.
该研究纳入了 1848 名接受化疗/利妥昔单抗治疗的弥漫性大 B 细胞淋巴瘤 (DLBCL) 患者。目的是验证国家综合癌症网络国际预后指数 (NCCN-IPI)，并探讨添加高 Beta-2 微球蛋白 (β 2M)、原发性结外表现和强化治疗对 NCCN-IPI 变量的影响，以便开发改进的指数。比较生存曲线，NCCN-IPI 比 IPI 具有更好的区分能力，区分了四个风险组，5 年总体生存率分别为 93%、83%、67% 和 49%，但未能识别出真正的高危人群。对于第二个目标，该系列被分为训练和验证队列：在前者中，多变量模型将年龄、乳酸脱氢酶、东部肿瘤合作组表现状态、III-IV 期和 beta M-2 确定为独立显着的，而 NCCN-IPI 选择的结外部位、原发结外表现和强化治疗则不然。这些结果在验证队列中得到了证实。这里开发的 Grupo Espanol de Linfomas/Trasplante de Medula osea (GELTAMO)-IPI 得分为 7 分，显着区分了四个风险组（0、1-3、4 或 >= 5 分），患者分别为 11%、58%、17% 和 14%，5 年总生存率分别为 93%、79%、66% 和 39%。在比较中，GELTAMO IPI 的辨别能力优于 NCCN-IPI。总之，GELTAMO-IPI 比 NCCN-IPI 更准确，并且具有统计和实践优势，因为可以更好地辨别真正的高危人群，并且不受原发结外表现或不同强度治疗的影响。
The study included 1848 diffuse large B-cell lymphoma (DLBCL) patients treated with chemotherapy/rituximab. The aims were to validate the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) and explore the effect of adding high Beta-2 microglobulin (beta 2M), primary extranodal presentation and intense treatment to the NCCN-IPI variables in order to develop an improved index. Comparing survival curves, NCCN-IPI discriminated better than IPI, separating four risk groups with 5-year overall survival rates of 93%, 83%, 67% and 49%, but failing to identify a true high-risk population. For the second aim the series was split into training and validation cohorts: in the former the multivariate model identified age, lactate dehydrogenase, Eastern Cooperative Oncology Group performance status, Stage III-IV, and beta M-2 as independently significant, whereas the NCCN-IPI-selected extranodal sites, primary extranodal presentation and intense treatments were not. These results were confirmed in the validation cohort. The Grupo Espanol de Linfomas/Trasplante de Medula osea (GELTAMO)-IPI developed here, with 7 points, significantly separated four risk groups (0, 1-3, 4 or >= 5 points) with 11%, 58%, 17% and 14% of patients, and 5-year overall survival rates of 93%, 79%, 66% and 39%, respectively. In the comparison GELTAMO IPI discriminated better than the NCCN-IPI. In conclusion, GELTAMO-IPI is more accurate than the NCCN-IPI and has statistical and practical advantages in that the better discrimination identifies an authentic high-risk group and is not influenced by primary extranodal presentation or treatments of different intensity.