Antic Darko, Jelicic Jelena, Trajkovic Goran, Balint Milena Todorovic, Bila Jelena, Markovic Olivera, Petkovic Ivan, Nikolic Vesna, Andjelic Bosko, Djurasinovic Vladislava, Sretenovic Aleksandra, Smiljanic Mihailo, Vukovic Vojin, Mihaljevic Biljana
Clinic of Hematology, Clinical Center of Serbia, 2 Koste Todorovica Str, Belgrade, 11000, Serbia.
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Ann Hematol. 2018 Feb;97(2):267-276. doi: 10.1007/s00277-017-3170-z. Epub 2017 Nov 12.
The prognostic value of the International Prognostic Index (IPI) has been re-evaluated in the rituximab-treated diffuse large B cell lymphoma (DLBCL) patients. Accordingly, National Comprehensive Cancer Network-IPI (NCCN-IPI) has been introduced to estimate prognosis of DLBCL patients. However, comorbidities that frequently affect elderly DLBCL patients were not analyzed. The aim of this study was to evaluate the prognostic significance of comorbidities using Charlson Comorbidity Index (CCI) in 962 DLBCL patients. According to CCI, majority of patients (73.6%) did not have any comorbidity, while high CCI (≥ 2) was observed in 71/962 (7.4%) patients, and in 55/426 (12.9%) of the elderly patients aged ≥ 60 years. When the CCI was analyzed in a multivariate model along with the NCCN-IPI parameters, it stood out as a threefold independent risk factor of a lethal outcome. Also, we have developed a novel comorbidity-NCCN-IPI (cNCCN-IPI) by adding additional 3 points if the patient had a CCI ≥ 2. Four risk groups emerged with the following patient distribution in low, low-intermediate, high-intermediate, and high group: 3.4, 34.3, 49.4, and 12.5%, respectively. The prognostic value of the new cNCCN-IPI was 2.1% improved compared to that of the IPI, and 1.3% improved compared to that of the NCCN-IPI (p < 0.05). This difference was more pronounced in elderly patients, in whom the cNCCN-IPI showed a 5.1% better discriminative power compared to that of the IPI, and 3.6% better compared to the NCCN-IPI. The NCCN-IPI enhanced by the CCI and combined with redistributed risk groups is better for differentiating risk categories in unselected DLBCL patients, especially in the elderly.
国际预后指数（IPI）在接受利妥昔单抗治疗的弥漫性大B细胞淋巴瘤（DLBCL）患者中的预后价值已被重新评估。相应地，国家综合癌症网络IPI（NCCN-IPI）已被引入以评估DLBCL患者的预后。然而，经常影响老年DLBCL患者的合并症未被分析。本研究的目的是使用Charlson合并症指数（CCI）评估962例DLBCL患者中合并症的预后意义。根据CCI，大多数患者（73.6%）没有任何合并症，而在71/962（7.4%）例患者中观察到高CCI（≥2），在≥60岁的55/426（12.9%）老年患者中观察到高CCI。当在多变量模型中连同NCCN-IPI参数一起分析CCI时，它成为致死结局的三倍独立危险因素。此外，如果患者的CCI≥2，我们通过额外增加3分开发了一种新的合并症-NCCN-IPI（cNCCN-IPI）。出现了四个风险组，低、低-中、高-中、高组的患者分布如下：分别为3.4%、34.3%、49.4%和12.5%。新的cNCCN-IPI的预后价值比IPI提高了2.1%，比NCCN-IPI提高了1.3%（p<0.05）。这种差异在老年患者中更为明显，其中cNCCN-IPI与IPI相比显示出5.1%更好的鉴别力，与NCCN-IPI相比显示出3.6%更好的鉴别力。由CCI增强并结合重新分布的风险组的NCCN-IPI在未选择的DLBCL患者中，尤其是在老年患者中，更有利于区分风险类别。
