Winter J N, Andersen J, Variakojis D, Gordon L I, Fisher R I, Oken M M, Neiman R S, Jiang S, Bauer K D
Robert Lurie Cancer Center, Northwestern University, Chicago, IL, USA.
Blood. 1996 Nov 15;88(10):3919-25.
The International Index is a powerful predictor of outcome in the aggressive non-Hodgkin's lymphomas that is based solely on clinical features. Proliferative activity (% S-phase) measured by flow cytometry has been reported to have prognostic significance in many series and may represent a biologic correlate of clinical behavior that further defines prognosis. Flow cytometric analysis of cellular DNA content and proliferative activity (% S-phase) was performed on fixed paraffin-embedded biopsy specimens from 242 previously untreated patients with diffuse, aggressive non-Hodgkin's lymphomas entered on phase III intergroup clinical trials. The International Index was calculated for each patient based on stage, lactate dehydrogenase, performance status, number of extranodal sites, and age, as previously reported. The International Index consistently predicted response to therapy (P = .027) and survival (P = .007) in this series. DNA aneuploidy was shown in 57% of cases, but was not predictive of clinical outcome. The median % S-phase was 9.9 (median coefficient of variation, 3.6%), which was highly correlated with mitotic index (P = .0001). Although a trend associating low proliferative activity with good early survival and very high S-phase with a shortened survival was shown, International Index risk was the only significant predictor of survival in the multivariate analysis. Although proliferative activity quantitated by flow cytometric analysis of nuclei extracted from paraffin-embedded specimens is probably predictive of survival, it is a less powerful prognostic indicator than clinical parameters represented by the International Index and provides no additional prognostic information.
国际预后指数是侵袭性非霍奇金淋巴瘤预后的有力预测指标，它仅基于临床特征。据报道，通过流式细胞术测量的增殖活性（S期百分比）在许多研究系列中具有预后意义，可能代表临床行为的生物学关联，进一步明确预后。对242例先前未接受治疗、参加III期组间临床试验的弥漫性侵袭性非霍奇金淋巴瘤患者的固定石蜡包埋活检标本进行了细胞DNA含量和增殖活性（S期百分比）的流式细胞术分析。如先前报道，根据分期、乳酸脱氢酶、体能状态、结外部位数量和年龄为每位患者计算国际预后指数。在本系列中，国际预后指数始终能预测对治疗的反应（P = 0.027）和生存率（P = 0.007）。57%的病例显示有DNA非整倍体，但它不能预测临床结果。S期百分比中位数为9.9（变异系数中位数为3.6%），与有丝分裂指数高度相关（P = 0.0001）。尽管显示出低增殖活性与良好的早期生存率相关，而非常高的S期与缩短的生存期相关的趋势，但在多变量分析中，国际预后指数风险是生存的唯一显著预测指标。尽管通过对石蜡包埋标本中提取的细胞核进行流式细胞术分析定量的增殖活性可能预测生存率，但它作为预后指标的效力不如国际预后指数所代表的临床参数，并且不能提供额外的预后信息。
