Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Front Cell Infect Microbiol. 2022 Jul 6;12:919446. doi: 10.3389/fcimb.2022.919446. eCollection 2022.
A simple and clinically applicable prognostic scoring system for AIDS-related lymphoma (ARL) in the era of combination antiretroviral therapy (cART) is needed to better stratify patients' risks and to assist in the decision-making of therapeutic strategies.
We conducted a retrospective multicenter cohort study in 138 primary ARL patients over an 8-year period from 2013 to 2020. Survival curves were estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazard models were performed to identify the association between patient-, lymphoma-, and HIV-specific variables with progression-free survival (PFS) and overall survival (OS). The incremental prognostic value of novel inflammatory biomarkers in the International Prognostic Index (IPI) was evaluated by comparing the receiver operating characteristic (ROC) curves, the concordance index (C-index), and the integrated Brier score (IBS).
The median age was 49.14 ± 14.20 (range 18-79) years, 81.9% were men, and the median follow-up was 44.94 (95% CI = 37.05-52.84) months. The 3-year OS and PFS were 39.4% (95% CI = 16.3-21.2) and 38.7% (95% CI = 14.5-19.7), respectively. We found that age, extranodal sites, bulky mass, CD4 T-cell counts, CD4/CD8 ratio, and hypoalbuminemia were associated with OS (all < 0.05) at both univariate and multivariate analyses. Of the new inflammatory markers, only the CD4/CD8 ratio was an independent prognostic parameter of OS and PFS. A lower CD4/CD8 ratio was strongly associated with adverse clinical factors, including older age, advanced Ann Arbor stage, more extranodal sites, elevated erythrocyte sedimentation rate, prior history of HIV, higher red cell distribution width ratio, hypoproteinemia, and emaciation. When the CD4/CD8 ratio was added to the IPI, the composite HIV-IPI score showed significantly better discrimination than IPI alone [AUC (95% CI): HIV-IPI, 0.83 (0.77-0.89) vs. IPI, 0.72 (0.70-0.85)]. The HIV-IPI model provided good predictive performance [C-index (95% CI): HIV-IPI, 0.82 (0.81-0.83) vs. IPI, 0.75 (0.73-0.77), < 0.001] and a satisfactory calibration function.
The CD4/CD8 ratio, an inexpensive and readily available marker, is a powerful independent prognostic parameter in patients with ARL. Furthermore, when the CD4/CD8 ratio is used in combination with IPI, it increases prognostic ability. The useful prediction of expected outcomes in ARL can inform treatment decisions.
在联合抗逆转录病毒疗法（cART）时代，我们需要一种简单且适用于临床的艾滋病相关淋巴瘤（ARL）预后评分系统，以便更好地分层患者的风险，并协助治疗策略的决策。
我们对 2013 年至 2020 年期间的 138 例原发性 ARL 患者进行了回顾性多中心队列研究。采用 Kaplan-Meier 法估计生存曲线。使用单变量和多变量 Cox 比例风险模型来确定患者、淋巴瘤和 HIV 特异性变量与无进展生存（PFS）和总生存（OS）之间的关联。通过比较受试者工作特征（ROC）曲线、一致性指数（C-index）和综合 Brier 评分（IBS）来评估新型炎症生物标志物在国际预后指数（IPI）中的增量预后价值。
中位年龄为 49.14±14.20 岁（范围 18-79 岁），81.9%为男性，中位随访时间为 44.94 个月（95%CI=37.05-52.84）。3 年 OS 和 PFS 分别为 39.4%（95%CI=16.3-21.2）和 38.7%（95%CI=14.5-19.7）。我们发现年龄、结外部位、肿块大小、CD4 T 细胞计数、CD4/CD8 比值和低白蛋白血症与 OS 相关（均<0.05），无论是在单变量还是多变量分析中。在新的炎症标志物中，只有 CD4/CD8 比值是 OS 和 PFS 的独立预后参数。较低的 CD4/CD8 比值与不良的临床因素密切相关，包括年龄较大、晚期 Ann Arbor 分期、更多的结外部位、红细胞沉降率升高、既往 HIV 病史、较高的红细胞分布宽度比值、低蛋白血症和消瘦。当 CD4/CD8 比值被添加到 IPI 中时，复合 HIV-IPI 评分的区分度明显优于 IPI 单独评分[AUC（95%CI）：HIV-IPI，0.83（0.77-0.89）比 IPI，0.72（0.70-0.85）]。HIV-IPI 模型提供了良好的预测性能[C-index（95%CI）：HIV-IPI，0.82（0.81-0.83）比 IPI，0.75（0.73-0.77），<0.001]和令人满意的校准功能。
CD4/CD8 比值是一种廉价且易于获得的标志物，是 ARL 患者强有力的独立预后参数。此外，当 CD4/CD8 比值与 IPI 联合使用时，它可以提高预后能力。对 ARL 预期结果的良好预测可以为治疗决策提供信息。
