Department of Hematology, Vejle Hospital, Sygehus Lillebaelt, Vejle, Denmark.
Department of Hematology, Odense University Hospital, Odense, Denmark.
Blood Cancer J. 2023 Oct 13;13(1):157. doi: 10.1038/s41408-023-00930-7.
Currently, the International Prognostic Index (IPI) is the most used and reported model for prognostication in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). IPI-like variations have been proposed, but only a few have been validated in different populations (e.g., revised IPI (R-IPI), National Comprehensive Cancer Network IPI (NCCN-IPI)). We aimed to validate and compare different IPI-like variations to identify the model with the highest predictive accuracy for survival in newly diagnosed DLBCL patients. We included 5126 DLBCL patients treated with immunochemotherapy with available data required by 13 different prognostic models. All models could predict survival, but NCCN-IPI consistently provided high levels of accuracy. Moreover, we found similar 5-year overall survivals in the high-risk group (33.4%) compared to the original validation study of NCCN-IPI. Additionally, only one model incorporating albumin performed similarly well but did not outperform NCCN-IPI regarding discrimination (c-index 0.693). Poor fit, discrimination, and calibration were observed in models with only three risk groups and without age as a risk factor. In this extensive retrospective registry-based study comparing 13 prognostic models, we suggest that NCCN-IPI should be reported as the reference model along with IPI in newly diagnosed DLBCL patients until more accurate validated prognostic models for DLBCL become available.
目前，国际预后指数（IPI）是用于预测新诊断弥漫性大 B 细胞淋巴瘤（DLBCL）患者预后的最常用和报告的模型。已经提出了类似于 IPI 的变化，但只有少数在不同人群中得到了验证（例如，修订后的 IPI（R-IPI）、国家综合癌症网络 IPI（NCCN-IPI））。我们旨在验证和比较不同的类似于 IPI 的变化，以确定哪种模型对新诊断的 DLBCL 患者的生存预测最准确。我们纳入了 5126 名接受免疫化疗治疗且有 13 种不同预后模型所需数据的 DLBCL 患者。所有模型都可以预测生存，但 NCCN-IPI 始终提供了较高的准确性。此外，我们发现高危组（33.4%）的 5 年总生存率与 NCCN-IPI 的原始验证研究相似。此外，只有一个包含白蛋白的模型表现相似，但在区分度方面并不优于 NCCN-IPI（c 指数 0.693）。在只有三个风险组且没有年龄作为风险因素的模型中，观察到拟合不良、区分度差和校准不良。在这项比较 13 种预后模型的广泛回顾性基于登记的研究中，我们建议在新诊断的 DLBCL 患者中，NCCN-IPI 应与 IPI 一起作为参考模型报告，直到更准确的验证性 DLBCL 预后模型可用。
