Department of Internal Medicine, Fukuoka University, Jonan, Fukuoka, Japan.
J Clin Oncol. 2012 May 10;30(14):1635-40. doi: 10.1200/JCO.2011.38.2101. Epub 2012 Apr 2.
The prognosis of acute- and lymphoma-type adult T-cell leukemia/lymphoma (ATL) is poor, but there is marked diversity in survival outcomes. The aim of this study was to develop a prognostic index (PI) for acute- and lymphoma-type ATL (ATL-PI).
In a retrospective review, data from 807 patients newly diagnosed with acute- and lymphoma-type ATL between January 2000 and May 2009 were evaluated. We randomly divided subjects into training (n = 404) and validation (n = 403) samples, and developed a PI using a multivariable fractional polynomial model.
Median overall survival time (MST) for the 807 patients was 7.7 months. The Ann Arbor stage (I and II v III and IV), performance status (0 to 1 v 2 to 4), and three continuous variables (age, serum albumin, and soluble interleukin-2 receptor [sIL-2R]) were identified as independent prognostic factors in the training sample. Using these variables, a prognostic model was devised to identify different levels of risk. In the validation sample, MSTs were 3.6, 7.3, and 16.2 months for patients at high, intermediate, and low risk, respectively (P < .001; χ(2) = 89.7, 2 df; log-rank test). We also simplified the original ATL-PI according to dichotomizing age at 70 years, serum albumin at 3.5 g/dL, and sIL-2R at 20,000 U/mL and developed an easily calculable PI with prognostic discrimination power (P < .001; χ(2) = 74.2, 2 df; log-rank test).
The ATL-PI is a promising new tool for identifying patients with acute- and lymphoma-type ATL at different risks.
成人 T 细胞白血病/淋巴瘤（ATL）的急淋和淋巴瘤型预后较差，但生存结果存在明显差异。本研究旨在建立急淋和淋巴瘤型 ATL（ATL-PI）的预后指数（PI）。
回顾性分析 2000 年 1 月至 2009 年 5 月期间新诊断为急淋和淋巴瘤型 ATL 的 807 例患者的数据。我们将患者随机分为训练（n=404）和验证（n=403）样本，使用多变量分数多项式模型建立 PI。
807 例患者的中位总生存期（MST）为 7.7 个月。Ann Arbor 分期（I 和 II 期比 III 和 IV 期）、体能状态（0-1 分比 2-4 分）和 3 个连续变量（年龄、血清白蛋白和可溶性白细胞介素-2 受体[sIL-2R]）在训练样本中被确定为独立的预后因素。使用这些变量，我们设计了一个预后模型来识别不同风险水平的患者。在验证样本中，高、中、低危患者的 MST 分别为 3.6、7.3 和 16.2 个月（P<0.001；χ(2)=89.7，2 自由度；对数秩检验）。我们还根据年龄是否大于 70 岁、血清白蛋白是否大于 3.5g/dL、sIL-2R 是否大于 20,000U/mL 将原始 ATL-PI 进行简化，开发了一种具有预后判别能力的易于计算的 PI（P<0.001；χ(2)=74.2，2 自由度；对数秩检验）。
ATL-PI 是一种有前途的新工具，可用于识别不同风险的急淋和淋巴瘤型 ATL 患者。
