Department of Hematology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.
Cancer. 2024 Oct 1;130(19):3321-3332. doi: 10.1002/cncr.35378. Epub 2024 May 29.
The histological transformation (HT) of follicular lymphoma (FL) is a crucial biological event. The study aimed to evaluate the incidence, clinicial characteristics, prognosis and impact of HT time on survival of FL transforming to diffuse large B-cell lymphoma in population-based large-scale cohorts.
A retrospective cohort study of FL with HT was performed in the Surveillance, Epidemiology, and End Results database. The Hematological Malignancy Research Network FL cohort and Aristotle study FL cohort were used to assess the external validity.
Among 44,127 FL cases from the Surveillance, Epidemiology, and End Results database, 1311 cases were pathology-proven recorded to transform to diffuse large B-cell lymphoma. The cumulative rates of HT at 5, 10, and 15 years after FL diagnosis were estimated to be 1.19%, 2.93%, and 5.01%, respectively. Significantly worse overall survival and cancer-specific survival were exhibited in patients with HT than those without HT. Early HT (transformation of FL within 48 months after FL diagnosis [TOD48]) was an independent predictor for adverse overall survival of HT patients, regardless of treatment modalities before transformation. The adverse prognostic effect of TOD48 was validated in the Hematological Malignancy Research Network cohort and Aristotle study cohort. Older age (>75 years) and B symptoms within FL at diagnosis were the independent risk factors of TOD48. Furthermore, a novel prognostic model combining TOD48 with Follicular Lymphoma International Prognostic Index (TOD48-FLIPI) was constructed and validated for risk stratification.
TOD48 was a risk indicator of HT, and the novel prognostic model "TOD48-FLIPI" for HT patients was proposed.
滤泡性淋巴瘤（FL）的组织学转化（HT）是一个关键的生物学事件。本研究旨在评估基于人群的大型队列中滤泡性淋巴瘤转化为弥漫性大 B 细胞淋巴瘤的 HT 发生率、临床特征、预后以及 HT 时间对生存的影响。
对监测、流行病学和最终结果数据库中的 HT 滤泡性淋巴瘤进行回顾性队列研究。使用血液恶性肿瘤研究网络 FL 队列和亚里士多德研究 FL 队列评估外部有效性。
在监测、流行病学和最终结果数据库中 44127 例 FL 病例中，有 1311 例病理证实记录为转化为弥漫性大 B 细胞淋巴瘤。FL 诊断后 5、10 和 15 年的 HT 累积发生率估计分别为 1.19%、2.93%和 5.01%。HT 患者的总生存率和癌症特异性生存率明显低于无 HT 患者。早期 HT（FL 诊断后 48 个月内发生的 HT [TOD48]）是 HT 患者不良总生存率的独立预测因素，无论转化前的治疗方式如何。TOD48 的不良预后作用在血液恶性肿瘤研究网络队列和亚里士多德研究队列中得到了验证。老年（>75 岁）和 FL 诊断时的 B 症状是 TOD48 的独立危险因素。此外，构建并验证了一种结合 TOD48 和滤泡性淋巴瘤国际预后指数（TOD48-FLIPI）的新的预后模型，用于风险分层。
TOD48 是 HT 的风险指标，提出了用于 HT 患者的新预后模型“TOD48-FLIPI”。
