Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Oncologist. 2019 Nov;24(11):e1251-e1261. doi: 10.1634/theoncologist.2018-0361. Epub 2019 Apr 5.
This study aimed to develop a prognostic nomogram in diffuse large B-cell lymphoma (DLBCL) and compare it with traditional prognostic systems.
We included 1,070 consecutive and nonselected patients with DLBCL in the National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, between 2006 and 2012. A nomogram based on the Cox proportional hazards model was developed.
The entire group were divided into the primary ( = 748) and validation ( = 322) cohorts. The 5-year overall survival (OS) rate was 64.1% for the entire group. Based on a multivariate analysis of the primary cohort, seven independent prognostic factors including age, Ann Arbor stage, Eastern Cooperative Oncology Group performance status score, lactate dehydrogenase, β2-microglobulin, CD5 expression, and Ki-67 index were identified and entered the nomogram. The calibration curve showed the optimal agreement between nomogram prediction and actual observation. In addition, the concordance index (C-index) of the nomogram for OS prediction was 0.77 (95% confidence interval [CI], 0.73-0.81) in the primary cohort and 0.76 (95% CI, 0.70-0.81) in the validation, superior to that of the international prognostic index (IPI), revised IPI (R-IPI), and National Comprehensive Cancer Network (NCCN)-IPI (range, 0.69-0.74, <.0001). Moreover, in patients receiving rituximab plus CHOP (R-CHOP) or R-CHOP-like regimens, compared with IPI (C-index, 0.73; 95% CI, 0.69-0.77), R-IPI (C-index, 0.70; 95% CI, 0.66-0.74), or NCCN-IPI (C-index, 0.71; 95% CI, 0.66-0.75), the DLBCL-specific nomogram showed a better discrimination capability ( < .0001).
The proposed nomogram provided an accurate estimate of survival of patients with DLBCL, especially for those receiving R-CHOP or R-CHOP-like regimens, allowing clinicians to optimized treatment plan based on individualized risk prediction.
A diffuse large B-cell lymphoma (DLBCL)-specific prognostic nomogram was developed based on Chinese patients with DLBCL. As a tertiary hospital, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences is the number 1 ranked cancer center in China, with more than 800,000 outpatients in 2018. Patients included in this study were nonselected and came from 29 different provinces, municipalities, and autonomous regions in China. Thus, the data is believed to be representative to an extent.
本研究旨在开发弥漫性大 B 细胞淋巴瘤（DLBCL）的预后列线图，并将其与传统预后系统进行比较。
我们纳入了 2006 年至 2012 年间在中国医学科学院国家癌症中心/国家临床医学研究中心/癌症医院连续收治的 1070 例非选择性 DLBCL 患者。基于 Cox 比例风险模型开发了一个列线图。
整个队列被分为原发性（n=748）和验证性队列（n=322）。整个队列的 5 年总生存率（OS）为 64.1%。基于原发性队列的多变量分析，确定了 7 个独立的预后因素，包括年龄、Ann Arbor 分期、东部合作肿瘤学组表现状态评分、乳酸脱氢酶、β2-微球蛋白、CD5 表达和 Ki-67 指数，并将其纳入列线图。校准曲线显示列线图预测与实际观察之间存在最佳一致性。此外，原发性队列中 OS 预测的列线图一致性指数（C-index）为 0.77（95%置信区间[CI]，0.73-0.81），验证性队列为 0.76（95%CI，0.70-0.81），优于国际预后指数（IPI）、修订的 IPI（R-IPI）和国家综合癌症网络（NCCN）-IPI（范围，0.69-0.74，<.0001）。此外，在接受利妥昔单抗联合 CHOP（R-CHOP）或 R-CHOP 样方案治疗的患者中，与 IPI（C-index，0.73；95%CI，0.69-0.77）、R-IPI（C-index，0.70；95%CI，0.66-0.74）或 NCCN-IPI（C-index，0.71；95%CI，0.66-0.75）相比，DLBCL 特异性列线图具有更好的区分能力（<.0001）。
所提出的列线图为 DLBCL 患者的生存提供了准确的估计，特别是对于接受 R-CHOP 或 R-CHOP 样方案治疗的患者，使临床医生能够根据个体风险预测来优化治疗方案。
本研究基于中国 DLBCL 患者建立了一个弥漫性大 B 细胞淋巴瘤（DLBCL）的预后列线图。中国医学科学院国家癌症中心/癌症医院作为一家三级医院，是中国排名第一的癌症中心，2018 年有超过 80 万门诊患者。本研究纳入的患者是非选择性的，来自中国 29 个不同的省、市、自治区。因此，数据在一定程度上具有代表性。
