Survival prognostic model for diffuse large B-cell lymphoma after R-CHOP chemotherapy
Objective To establish a survival prognosis model for diffuse large B-cell lymphoma(DLBCL)after R-CHOP chemotherapy(rituximab,cyclophosphamide,doxorubicin,vincristine,prednisolone)to guide the risk stratification of patients.Methods A total of 210 patients diagnosed as DLBCL in Jinhua Municipal Central Hospital were retrospectively enrolled from January 2018 to January 2023.They were randomly divided into a training set of 140 patients and a validation set of 70 cases based on a ratio of 2:1.All patients received R-CHOP chemotherapy for at least 4 courses of treatment(21 days as 1 course),and were followed up routinely until June 2023.According to the survival prognosis,patients were divided into the favorable and adverse groups.Their clinical information[including gender,age,body mass index,chronic comorbidity,serum lactate dehydrogenase(LDH),National Comprehensive Cancer Network international prognostic index(NCCN-IPI)],pathological characteristics[including Hans classification,Ann Arbor staging,primary sites,Ki-67 positive expression rate,MYC and B-cell lymphoma-2(Bcl-2)protein positive expression,and bone marrow invasion],treatment landscape(chemotherapy course and complications),and follow-up time were compared.Results In the training set,there were 105 cases in the favorable group and 35 cases in the adverse group,with the adverse prognosis rate of 25.0％.In contrast,the validation set consisted of 55 cases in the favorable group and 15 cases in the adverse group,with the adverse prognosis rate of 21.4％.Univariate analyses found that in the training set,patients of the adverse group were older than the favorable group,and their LDH level,NCCN-IPI,ratio of Ann Arbor stages Ⅲ-Ⅳ,positive expression rate of Ki-67,double positive expressions of MYC and Bcl-2 proteins,and ratio of bone marrow invasion were all significantly higher than the favorable group(all P＜0.05).Multivariate Cox regression analysis showed that NCCN-IPI(HR=2.526,95％CI:2.001-3.125,P＜0.001),Ann Arbor stages Ⅲ-Ⅳ(HR=5.021,95％CI:4.125-5.998,P＜0.001),and double positive expression of MYC and Bcl-2 proteins(HR=3.859,95％ CI:3.256-4.754,P＜0.001)remained as the significant adverse predictors for DLBCL patients received R-CHOP chemotherapy.Finally,we established a predictive model:Y=0.056+1.032 x(NCCN-IPI)+1.986 x(Ann Arbor staging)+1.434 x(MYC and Bcl-2 double expression).The receiver operating curve(ROC)showed that the area under the curve(AUC)of the training and validation sets in predicting adverse prognosis were 0.923 and 0.866,respectively(both P＜0.01).Conclusion Elevated NCCN-IPI,advanced Ann Arbor staging,and double expression of MYC and Bcl-2 proteins before chemotherapy are closely related to the poor clinical outcomes of DLBCL patients after R-CHOP chemotherapy.This prognostic model can assist in clinical practice for early and accurate identification of patients with high risk for poor outcomes,which has good application value.
MYCB-cell lymphoma-2Diffuse large B-cell lymphomaModelNational Comprehensive Cancer Network international prognostic index
万方数据
维普
