Development and Validation of a Novel Risk Stratification Model for Cancer-Specific Survival in Diffuse Large B-Cell Lymphoma

Frontiers in Oncology ◽

10.3389/fonc.2020.582567 ◽

2021 ◽

Vol 10 ◽

Author(s):

Qiaofeng Zhong ◽

Yuankai Shi

Keyword(s):

Survival Rate ◽

Risk Stratification ◽

Predictive Accuracy ◽

B Cell Lymphoma ◽

Cancer Specific Survival ◽

Web Based ◽

Large B Cell Lymphoma ◽

Risk Stratification Model ◽

Ann Arbor

Diffuse large B-cell lymphoma (DLBCL) is a biologically and clinically heterogenous disease. Identifying more precise and individual survival prognostic models are still needed. This study aimed to develop a predictive nomogram and a web-based survival rate calculator that can dynamically predict the long-term cancer-specific survival (CSS) of DLBCL patients. A total of 3,573 eligible patients with DLBCL from 2004 to 2015 were extracted from the Surveillance, Epidemiology and End Results (SEER) database. The entire group was randomly divided into the training (n = 2,504) and validation (n = 1,069) cohorts. We identified six independent predictors for survival including age, sex, marital status, Ann Arbor stage, B symptom, and chemotherapy, which were used to construct the nomogram and the web-based survival rate calculator. The C-index of the nomogram was 0.709 (95% CI, 0.692–0.726) in the training cohort and 0.700 (95% CI, 0.671–0.729) in the validation cohort. The AUC values of the nomogram for predicting the 1-, 5-, and 10- year CSS rates ranged from 0.704 to 0.765 in both cohorts. All calibration curves revealed optimal consistency between predicted and actual survival. A risk stratification model generated based on the nomogram showed a favorable level of predictive accuracy compared with the IPI, R-IPI, and Ann Arbor stage in both cohorts according to the AUC values (training cohort: 0.715 vs 0.676, 0.652, and 0.648; validation cohort: 0.695 vs 0.692, 0.657, and 0.624) and K-M survival curves. In conclusion, we have established and validated a novel nomogram risk stratification model and a web-based survival rate calculator that can dynamically predict the long-term CSS in DLBCL, which revealed more discriminative and predictive accuracy than the IPI, R-IPI, and Ann Arbor stage in the rituximab era.

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Development and Validation of a Novel Prognostic Nomogram Model and a Web-Based Survival Rate Calculator for Diffuse Large B-Cell Lymphoma in the Rituximab Era

Blood ◽

10.1182/blood-2021-154210 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 1450-1450

Author(s):

Qiaofeng Zhong ◽

Haizhu Chen ◽

Yan Qin ◽

Xiaohui He ◽

Sheng Yang ◽

...

Keyword(s):

Survival Rate ◽

B Cell ◽

Validation Cohort ◽

Predictive Accuracy ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Web Based ◽

Training Cohort ◽

Large B Cell Lymphoma ◽

Large B Cell

Abstract Objective This study aimed to develop a novel prognostic nomogram and a web-based survival rate calculator to improve discriminative and predictive accuracy for diffuse large B cell lymphoma (DLBCL) in rituximab era. Methods We retrospectively collected data about 906 DLBCL patients who received R-CHOP or R-CHOP-like chemotherapy from January 2005 to December 2018 in National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences. COX proportional hazard regression analysis was performed to assess the independent prognostic significance of clinical and histopathological variables on overall survival, which were used to develop the nomogram. We performed internal and external validation of the nomogram, and compared it's discriminative and predictive accuracy with the traditional IPI, R-IPI, and NCCN-IPI. ResultsThe patients were divided into the training (n = 636) and validation (n = 270) cohorts at a ratio of 7:3. We identified six independent predictors for survival including age, ECOG, number of extranodal sites, bulky, and β2-MG, which were used to construct the nomogram and the web-based survival rate calculator. The C-index of the nomogram was 0.767 (95% CI, 0.735-0.799) in the training cohort and 0.732 (95% CI, 0.678-0.786) in the validation cohort. The AUC values of the nomogram for predicting the 1-, 5-, and 10-year OS rates for DLBCL were 0.794, 0.799, 0.805 in the training cohort and 0.828, 0.773, 0.771 in the validation cohort. All calibration curves revealed optimal consistency between predicted and actual survival both in the training and validation cohort. The nomogram divided DLBCL patients into three risk groups, the score of low risk, moderate risk, and high risk were 0-45，46-228，and higher than 228, respectively. The risk stratification model generated based on the nomogram showed a favorable level of predictive accuracy compared with the IPI, R-IPI, and NCCN-IPI in both cohorts according to the K-M survival curves. The AUC values of the nomogram model compared with the IPI, R-IPI, and NCCN-IPI for predicting the 10-year OS rates for DLBCL patients were 0.756 vs 0.748, 0.732, 0.713 in the training cohort and 0.742 vs 0.712, 0.713, 0.757 in the validation cohort. ConclusionsIn conclusion, we have established and validated a novel prognostic nomogram model and a web-based survival rate calculator, which revealed more discriminative and predictive accuracy than IPI, R-IPI, and NCCN-IPI in the rituximab era. Disclosures No relevant conflicts of interest to declare.

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Risk stratification model based on VEGF and International Prognostic Index accurately identifies low-risk diffuse large B-cell lymphoma patients in the rituximab era

International Journal of Hematology ◽

10.1007/s12185-021-03145-3 ◽

2021 ◽

Author(s):

Wei Sang ◽

Hang Zhou ◽

Yuanyuan Qin ◽

Ziyuan Shen ◽

Dongmei Yan ◽

...

Keyword(s):

Risk Stratification ◽

B Cell ◽

Cell Lymphoma ◽

International Prognostic Index ◽

Prognostic Index ◽

B Cell Lymphoma ◽

Low Risk ◽

Large B Cell Lymphoma ◽

Risk Stratification Model ◽

Large B Cell

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Lymphome

Praxis ◽

10.1024/1661-8157/a002237 ◽

2016 ◽

Vol 105 (1) ◽

pp. 47-52 ◽

Cited By ~ 1

Author(s):

Andreas Lohri

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Staging System ◽

Maligne Lymphome ◽

Interim Pet ◽

Large B Cell Lymphoma ◽

Ann Arbor ◽

Large B Cell

Zusammenfassung. Maligne Lymphome unterteilen sich zwar in über 60 Entitäten, das grosszellige B-Zell-Lymphom, das follikuläre Lymphom, der Hodgkin und das Mantelzell-Lymphom machen aber mehr als die Hälfte aller Lymphome aus. Im revidierten Ann Arbor staging system gelten die Suffixe «A» und «B» nur noch für den Hodgkin. «E» erscheint nur noch bei Stadien I und II. Eine Knochenmarksuntersuchung wird beim Hodgkin nicht mehr verlangt, beim DLBCL (Diffuse large B cell lymphoma) nur, falls das PET keinen Knochenmark-Befall zeigt. Der PET-Untersuchung, speziell dem Interim-PET, kommt eine entscheidende Bedeutung zu. PET-gesteuerte Therapien führen zu weniger Toxizität. Gezielt wirkende Medikamente mit eindrücklicher Wirksamkeit wurden neu zugelassen. Deren Kosten sind hoch. Eine strahlen- und chemotherapiefreie Behandlung maligner Lymphome wird in Zukunft möglich sein.

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