Feng Y X, Su L P
Graduate School of Shanxi Medical University, Taiyuan 030000, China.
Department of Hematology, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030000, China.
Zhonghua Zhong Liu Za Zhi. 2020 Nov 23;42(11):949-954. doi: 10.3760/cma.j.cn112152-20200329-00271.
To compare the prognostic values of international prognostic index (IPI), revised international prognostic index (R-IPI), enhanced international prognostic index (NCCN-IPI) and Grupo Español de Linfomas/trasplante autólogo de médula ósea-international prognostic index (GELTAMO-IPI) for diffuse large B-cell lymphoma (DLBCL). The clinical data of 238 DLBCL patients who were initially treated in Shanxi Cancer Hospital from September 2011 to March 2016 were collected retrospectively, the risk stratification and prognostic evaluation were conducted according to the IPI, R-IPI, NCCN-IPI and GELTAMO-IPI. Survival analysis was performed by the Kaplan-Meier method, COX regression analysis was used to compare the risks of death and progress in each group. Harrell's C statistics was used to compare the prediction accuracy of each hazard stratification model. The 3-years progression-free survival rates of low risk, middle-low risk, middle-high risk and high risk group stratified according to IPI were 90.9%, 67.5%, 54.0% and 52.4%, respectively. The 3-years overall survival rates of each group were 93.9%, 72.5%, 58.0% and 53.7%, respectively. The 3-years progression-free survival rates of patients with very good prognosis, good prognosis and poor prognosis were 90.9%, 79.8% and 53.0%, respectively, the 3-years overall survival rates were 95.5%, 83.3% and 55.3%, respectively. The 3-years of progression-free survival of low risk group, middle-low risk group, middle-high risk group and high risk group stratified according to NCCN-IPI were 91.7%, 76.5%, 66.7% and 41.1%, respectively. The 3-years overall survival rates of each group were 95.8%, 79.4%, 70.0% and 42.9%, respectively. The 3-years progression-free survival rates of low risk, middle-low risk, middle-high risk and high risk group stratified according to GELTAMO-IPI were 91.3%, 76.3%, 67.4% and 32.7%, respectively. The 3-years overall survival rates of each group were 95.7%, 80.7%, 67.4% and 34.5%, respectively. Cox regression analysis showed that the risks of progression and death were significantly different between the middle-low risk group and low risk group of IPI (=4.144 and 5.085). The risks of progression and death were significantly different between the poor prognosis group and good prognosis group of R-IPI (=2.752 and 3.171), but both of which were significantly lower than the IPI groups. The risk stratification showed that the risks of progression and death were significantly different between the high risk group and middle-high risk group of NCCN-IPI and GELTAMO-IPI. However, the screening ability of high risk patients in GELTAMO-IPI group was better than that of NCCN-IPI group (NCCN-IPI =2.290 and 2.309, GELTAMO-IPI =3.084 and 2.966). Harrell's C-index analysis showed that the C-indexes of 3-years progression-free survival prediction in IPI, R-IPI, NCCN-IPI and GELTAM0-IPI were 0.672, 0.641, 0.664 and 0.700, respectively (<0.001). The C-indexes of 3-years overall survival prediction were 0.687, 0.653, 0.671 and 0.721, respectively (<0.001). The C-index of GETAMO-IPI was highest, superior to other prediction models. The screening abilities of GELTAMO-IPI and NCCN-IPI for high-risk DLBCL patients are better than those of IPI and R-IPI. The prediction accuracy of GELTAMO-IPI is significantly better than other prognostic stratified models.
比较国际预后指数（IPI）、修订后的国际预后指数（R-IPI）、强化国际预后指数（NCCN-IPI）和西班牙淋巴瘤/自体骨髓移植-国际预后指数（GELTAMO-IPI）对弥漫性大B细胞淋巴瘤（DLBCL）的预后价值。回顾性收集2011年9月至2016年3月在山西省肿瘤医院初治的238例DLBCL患者的临床资料，根据IPI、R-IPI、NCCN-IPI和GELTAMO-IPI进行风险分层和预后评估。采用Kaplan-Meier法进行生存分析，COX回归分析比较各组死亡和进展风险。采用Harrell's C统计量比较各危险分层模型的预测准确性。根据IPI分层的低危、中低危、中高危和高危组的3年无进展生存率分别为90.9%、67.5%、54.0%和52.4%。各组的3年总生存率分别为93.9%、72.5%、58.0%和53.7%。预后非常好、好和差的患者的3年无进展生存率分别为90.9%、79.8%和53.0%，3年总生存率分别为95.5%、83.3%和55.3%。根据NCCN-IPI分层的低危、中低危、中高危和高危组的3年无进展生存率分别为91.7%、76.5%、66.7%和41.1%。各组的3年总生存率分别为95.8%、79.4%、70.0%和42.9%。根据GELTAMO-IPI分层的低危、中低危、中高危和高危组的3年无进展生存率分别为91.3%、76.3%、67.4%和32.7%。各组的3年总生存率分别为95.7%、80.7%、67.4%和34.5%。COX回归分析显示，IPI中低危组与低危组之间的进展和死亡风险有显著差异（=4.144和5.085）。R-IPI中预后差组与预后好组之间的进展和死亡风险有显著差异（=2.752和3.171），但两者均显著低于IPI组。风险分层显示，NCCN-IPI和GELTAMO-IPI的高危组与中高危组之间的进展和死亡风险有显著差异。然而，GELTAMO-IPI组对高危患者的筛查能力优于NCCN-IPI组（NCCN-IPI =2.290和2.309，GELTAMO-IPI =3.084和2.966）。Harrell's C指数分析显示，IPI、R-IPI、NCCN-IPI和GELTAM0-IPI的3年无进展生存预测的C指数分别为0.672、0.641、0.664和0.700（<0.001）。3年总生存预测的C指数分别为0.687、0.653、0.671和0.721（<0.001）。GELTAMO-IPI的C指数最高，优于其他预测模型。GELTAMO-IPI和NCCN-IPI对高危DLBCL患者的筛查能力优于IPI和R-IPI。GELTAMO-IPI的预测准确性显著优于其他预后分层模型。
