A PREDICTIVE MODEL FOR AGGRESSIVE NON-HODGKINS-LYMPHOMA
A PREDICTIVE MODEL FOR AGGRESSIVE NON-HODGKINS-LYMPHOMA
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DOI：
10.1056/nejm199309303291402
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发表时间：
1993-09-30
影响因子：
158.5
通讯作者：
YEAP, BY
中科院分区：
文献类型：
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作者：
SHIPP, MA;HARRINGTON, DP;YEAP, BY
背景虽然许多患有中度或高度（侵袭性）非霍奇金淋巴瘤的患者通过联合化疗治愈，但其余患者无法治愈并最终死于疾病。安阿伯分类，用于确定这种疾病的阶段，并不一贯区分不同的长期患病的患者。本研究旨在根据侵袭性非霍奇金淋巴瘤患者治疗前的临床特征，建立一个预测预后的模型。来自美国、欧洲和加拿大16个机构和合作组的成人侵袭性非霍奇金淋巴瘤患者在1982年至1987年间接受了含阿霉素的联合化疗方案治疗，评估了预测总生存率和无复发生存率的临床特征。在生存率的逐步回归分析中保持独立显著性的特征被纳入模型中，该模型确定了所有年龄段的患者组和不超过60岁的患者组，这些患者组具有不同的死亡风险。在2031名所有年龄段的患者中，我们的模型基于年龄，肿瘤分期，血清乳酸脱氢酶浓度，体能状态和结节病部位的数量，确定了四个风险组，预测五年生存率为73%，51%，43%和26%。在1274名60岁或60岁以下的患者中，基于肿瘤分期、乳酸脱氢酶水平和体能状态的年龄调整模型确定了四个风险组，预测的五年生存率分别为83%、69%、46%和32%。在这两种模型中，死亡风险增加是由于完全缓解率较低和完全缓解后复发率较高。这两个指数，称为国际指数和年龄调整的国际指数，在预测长期生存率方面明显比安阿伯分类更准确。国际指数和年龄调整的国际指数应用于设计未来的治疗试验中的侵袭性非霍奇金淋巴瘤患者，并在选择适当的治疗方法，为个别患者。
Background. Although many patients with intermediate-grade or high-grade (aggressive) non-Hodgkin's lymphoma are cured by combination chemotherapy, the remainder are not cured and ultimately die of their disease. The Ann Arbor classification, used to determine the stage of this disease, does not consistently distinguish between patients with different long-term prognoses. This project was undertaken to develop a model for predicting outcome in patients with aggressive non-Hodgkin's lymphoma on the basis of the patients' clinical characteristics before treatment.Methods. Adults with aggressive non-Hodgkin's lymphoma from 16 institutions and cooperative groups in the United States, Europe, and Canada who were treated between 1982 and 1987 with combination-chemotherapy regimens containing doxorubicin were evaluated for clinical features predictive of overall survival and relapse-free survival. Features that remained independently significant in step-down regression analyses of survival were incorporated into models that identified groups of patients of all ages and groups of patients no more than 60 years old with different risks of death.Results. In 2031 patients of all ages, our model, based on age, tumor stage, serum lactate dehydrogenase concentration, performance status, and number of extranodal disease sites, identified four risk groups with predicted five-year survival rates of 73 percent, 51 percent, 43 percent, and 26 percent. In 1274 patients 60 or younger, an age-adjusted model based on tumor stage, lactate dehydrogenase level, and performance status identified four risk groups with predicted five-year survival rates of 83 percent, 69 percent, 46 percent, and 32 percent. In both models, the increased risk of death was due to both a lower rate of complete responses and a higher rate of relapse from complete response. These two indexes, called the international index and the age-adjusted international index, were significantly more accurate than the Ann Arbor classification in predicting long-term survival.Conclusions. The international index and the age-adjusted international index should be used in the design of future therapeutic trials in patients with aggressive non-Hodgkin's lymphoma and in the selection of appropriate therapeutic approaches for individual patients.