初诊 CD5 阳性弥漫大 B 细胞淋巴瘤患者预后营养指数（PNI）的价值：淮海淋巴瘤工作组的一项多中心回顾性研究。

Value of the prognostic nutritional index (PNI) in patients with newly diagnosed, CD5-positive diffuse large B-cell lymphoma: A multicenter retrospective study of the Huaihai Lymphoma Working Group.

机构信息

Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.

Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China.

出版信息

Cancer. 2022 Oct 1;128(19):3487-3494. doi: 10.1002/cncr.34405. Epub 2022 Aug 6.

DOI:10.1002/cncr.34405

PMID:35932292

Abstract

BACKGROUND

CD5-positive diffuse large B-cell lymphoma (DLBCL) is a clinically rare subtype of DLBCL with aggressive clinical manifestations and a poor prognosis. It has been demonstrated that the prognostic nutritional index (PNI), an indicator of nutritional status and systemic inflammation, is a significant prognostic factor for several types of lymphoma. The objective of this multicenter retrospective study was to explore the prognostic value of the PNI in patients with CD5-positive DLBCL.

METHODS

In total, 207 patients with CD5-positive DLBCL were recruited from 11 centers of the Huaihai Lymphoma Working Group. Maximally selected rank statistics analysis was used to identify optimal cutoff points for the PNI. A Cox proportional hazards model was used for univariable and multivariable analyses. Kaplan-Meier curves were used to calculate survival rates and draw survival curves, and the log-rank test was used to compare differences between groups.

RESULTS

The median age at diagnosis was 61 years, and the 5-year overall survival rate was 47.5%. According to the maximally selected rank statistics analysis, a score of 49.7 was the optimal cutoff point for the PNI. Subgroup analysis showed that the PNI could re-stratify patients in BCL-2-negative, MYC-negative, high-intermediate-risk and high-risk International Prognostic Index, BCL-6-positive and BCL-6-negative, high Ki-67 score (≥0.9), Ann Arbor stage III/IV, Eastern Cooperative Oncology Group performance status ≥2, and germinal center B subgroups. Multivariable analysis revealed that PNI, age, Eastern Cooperative Oncology Group performance status, albumin level, and red blood cell count were independent prognostic factors for CD5-positive DLBCL.

CONCLUSIONS

The PNI was a significant prognostic indicator for CD5-positive DLBCL and was able to re-stratify the prognosis for clinicopathologic subgroups of patients with CD5-positive DLBCL.

摘要

背景

CD5 阳性弥漫性大 B 细胞淋巴瘤（DLBCL）是一种临床罕见的 DLBCL 亚型，具有侵袭性临床表现和不良预后。已证实，预后营养指数（PNI）是一种反映营养状态和全身炎症的指标，是多种淋巴瘤的重要预后因素。本多中心回顾性研究的目的是探讨 PNI 在 CD5 阳性 DLBCL 患者中的预后价值。

方法

本研究共纳入 11 家淮海淋巴瘤工作组中心的 207 例 CD5 阳性 DLBCL 患者。采用最大选择秩检验分析确定 PNI 的最佳截断点。采用 Cox 比例风险模型进行单因素和多因素分析。Kaplan-Meier 曲线计算生存率并绘制生存曲线，对数秩检验比较组间差异。

结果

诊断时的中位年龄为 61 岁，5 年总生存率为 47.5%。根据最大选择秩检验分析，PNI 得分为 49.7 分为最佳截断点。亚组分析显示，PNI 可重新分层 BCL-2 阴性、MYC 阴性、高-中危国际预后指数、BCL-6 阳性和 BCL-6 阴性、高 Ki-67 评分（≥0.9）、Ann Arbor 分期 III/IV、ECOG 体能状态≥2 和生发中心 B 亚组。多因素分析显示，PNI、年龄、ECOG 体能状态、白蛋白水平和红细胞计数是 CD5 阳性 DLBCL 的独立预后因素。