Fujii Keiichiro, Inagaki Atsushi, Masaki Ayako, Sugiura Mariko, Suzuki Tomotaka, Ishida Takashi, Kusumoto Shigeru, Iida Shinsuke, Inagaki Hiroshi
Department of Pathology and Molecular Diagnostics, Graduate School of Medical Sciences, Nagoya City University, 1-Kawasumi, Mizuho-Ku, Nagoya, 467-8601, Japan.
Department of Hematology and Oncology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
Ann Hematol. 2024 Jun;103(6):2041-2050. doi: 10.1007/s00277-024-05669-0. Epub 2024 Feb 27.
The international prognostic index (IPI) system has been widely used to predict prognosis in diffuse large B-cell lymphoma (DLBCL). However, this system categorizes DLBCL patients into four risk groups, and cannot optimize individualized prognosis. In addition, other clinicopathological factors, such as molecular aberrations, are not incorporated into the system. To partly overcome these weak points, we developed nomograms to predict individual patient survival. We also incorporated MYD88 and CD79B mutations into the nomograms since these mutations are associated with a worse prognosis and their signaling pathways have been highlighted as a therapeutic target. We analyzed 302 DLBCL cases for which multivariate analysis by Cox proportional hazard regression was performed. Nomograms for progression-free survival (PFS) and overall survival (OS) were constructed and assessed by a concordance index (C-index). The nomograms were also evaluated using an open external dataset (n = 187). The MYD88 and/or CD79B (MYD88/CD79B) mutation was detected in 62/302 patients. The nomograms incorporating IPI factors exhibited a C-index of 0.738 for PFS and a C-index of 0.765 for OS. The nomograms incorporating IPI factors and the MYD88/CD79B mutation showed a C-index of 0.745 for PFS and a C-index of 0.769 for OS. The nomograms we created were evaluated using an external dataset and were well validated. The present nomograms incorporating IPI factors and the MYD88/CD79B mutation have sufficient discrimination ability, and may effectively predict prognosis in DLBCL patients. The prognostic models we have presented here may help clinicians personalize prognostic assessments and clinical decisions.
国际预后指数（IPI）系统已被广泛用于预测弥漫性大B细胞淋巴瘤（DLBCL）的预后。然而，该系统将DLBCL患者分为四个风险组，无法优化个体化预后。此外，其他临床病理因素，如分子异常，未纳入该系统。为了部分克服这些弱点，我们开发了列线图来预测个体患者的生存情况。我们还将MYD88和CD79B突变纳入列线图，因为这些突变与较差的预后相关，并且它们的信号通路已被强调为治疗靶点。我们分析了302例进行Cox比例风险回归多因素分析的DLBCL病例。构建了无进展生存期（PFS）和总生存期（OS）的列线图，并通过一致性指数（C指数）进行评估。还使用一个开放的外部数据集（n = 187）对列线图进行了评估。在62/302例患者中检测到MYD88和/或CD79B（MYD88/CD79B）突变。纳入IPI因素的列线图对于PFS的C指数为0.738，对于OS的C指数为0.765。纳入IPI因素和MYD88/CD79B突变的列线图对于PFS的C指数为0.745，对于OS的C指数为0.769。我们创建的列线图使用外部数据集进行了评估，并得到了很好的验证。目前纳入IPI因素和MYD88/CD79B突变的列线图具有足够的区分能力，可能有效地预测DLBCL患者的预后。我们在此提出的预后模型可能有助于临床医生进行个体化的预后评估和临床决策。
