Chronic Lymphocytic Leukemia Prognostic Index: A New Integrated Scoring System to Predict the Time to First Treatment in Chinese Patients with Chronic Lymphocytic Leukemia.
Chronic Lymphocytic Leukemia Prognostic Index: A New Integrated Scoring System to Predict the Time to First Treatment in Chinese Patients with Chronic Lymphocytic Leukemia.
复制标题
慢性淋巴细胞白血病预后指数：预测中国慢性淋巴细胞白血病患者首次治疗时间的新综合评分系统
DOI：
10.4103/0366-6999.197978
复制
发表时间：
2017-01-20
影响因子：
6.1
通讯作者：
Qiu LG
中科院分区：
文献类型：
--
作者：
Li H;Yi SH;Xiong WJ;Liu HM;Lyu R;Wang TY;Liu W;Zhong SZ;Yu Z;Zou DH;Xu Y;An G;Li ZJ;Qiu LG
背景资料：慢性淋巴细胞白血病（CLL）的临床分期系统（Rai/Binet）不能准确预测早期患者的适当治疗。在过去的二十年中，已经确定了几个预后因素来预测CLL患者的结局，但只有少数研究同时研究了更多的标志物。为了预测早期患者的首次治疗时间（TTFT），我们评估了常规标志物以及细胞遗传学异常的预后作用，并将它们结合在一个新的预后评分系统中，即CLL预后指数（CLL-PI）。研究方法：利用406例处于疾病早期和晚期的未经治疗的中国CLL患者的人群，我们确定了TTFT的最强预后标志物，随后，在173例具有所有3个变量的完整数据的患者的队列中，我们整合了CLL-PI中的传统分期系统、细胞遗传学畸变和免疫球蛋白重链可变区（IGHV）突变状态的数据。中位随访时间为45个月，终点为TTFT。结果：中位TTFT为38个月，5年总生存率为80%。根据单因素分析，晚期Rai患者（P < 0.001）或11 q-（P = 0.002）、17 p-（P < 0.001）、未突变IGHV（P <0.001）、13 q-（P = 0.007）和乳酸脱氢酶水平升高（P = 0.001）患者的TTFT往往显著缩短。多因素考克斯回归分析显示，临床分期（P = 0.002）、17 p-（P = 0.050）和未突变IGHV（P = 0.049）是TTFT的独立影响因素。应用这些独立因素的加权分级，基于回归参数构建CLL-PI，其可以将四个不同的风险组分类（低风险[评分0]、中等低风险[评分1]、中等高风险[评分2]和高风险[评分3-6]）中位TTFT未达到（NR）分别为65.0个月、36.0个月和19.0个月，P < 0.001。结论：本研究开发了一个加权的CLL-PI综合预后系统，该系统将关键的遗传预后标记与传统的临床分期相结合。这种新的改良PI系统可用于区分不同的组，并可能有助于预测TTFT和CLL患者的预后。
Background: The established clinical staging systems (Rai/Binet) of chronic lymphocytic leukemia (CLL) cannot accurately predict the appropriate treatment of patients in the earlier stages. In the past two decades, several prognostic factors have been identified to predict the outcome of patients with CLL, but only a few studies investigated more markers together. To predict the time to first treatment (TTFT) in patients of early stages, we evaluated the prognostic role of conventional markers as well as cytogenetic abnormalities and combined them together in a new prognostic scoring system, the CLL prognostic index (CLL-PI). Methods: Taking advantage of a population of 406 untreated Chinese patients with CLL at early and advanced stage of disease, we identified the strongest prognostic markers of TTFT and, subsequently, in a cohort of 173 patients who had complete data for all 3 variables, we integrated the data of traditional staging system, cytogenetic aberrations, and mutational status of immunoglobulin heavy chain variable region (IGHV) in CLL-PI. The median follow-up time was 45 months and the end point was TTFT. Results: The median TTFT was 38 months and the 5-year overall survival was 80%. According to univariate analysis, patients of advanced Rai stages (P < 0.001) or with 11q- (P = 0.002), 17p- (P < 0.001), unmutated IGHV (P < 0.001), negative 13q- (P = 0.007) and elevated lactate dehydrogenase levels (P = 0.001) tended to have a significantly shorter TTFT. And subsequently, based on multivariate Cox regression analysis, three independent factors for TTFT were identified: advanced clinical stage (P = 0.002), 17p- (P = 0.050) and unmutated IGHV (P = 0.049). Applying weighted grading of these independent factors, a CLL-PI was constructed based on regression parameters, which could categorize four different risk groups (low risk [score 0], intermediate low [score 1], intermediate high [score 2] and high risk [score 3–6]) with significantly different TTFT (median TTFT of not reached (NR), 65.0 months, 36.0 months and 19.0 months, respectively, P < 0.001). Conclusions: This study developed a weighted, integrated CLL-PI prognostic system of CLL patients which combines the critical genetic prognostic markers with traditional clinical stage. This novel modified PI system could be used to discriminate among groups and may help predict the TTFT and prognosis of patients with CLL.