Prognostic Model to Predict Overall Survival for Metastatic Non-Small Cell Lung Cancer Patients Treated With Chemotherapy Combined With Concurrent Radiation Therapy to the Primary Tumor: Analysis From Two Prospective Studies

PurposeThe role of radiotherapy, in addition to chemotherapy, has not been thoroughly determined in metastatic non-small cell lung cancer (NSCLC). The purpose of the study was to investigate the prognostic factors and to establish a model for the prediction of overall survival (OS) in metastatic NSCLC patients who received chemotherapy combined with the radiation therapy to the primary tumor.MethodsThe study retrospectively reviewed 243 patients with metastatic NSCLC in two prospective studies. A prognostic model was established based on the results of the Cox regression analysis.ResultsMultivariate analysis showed that being male, Karnofsky Performance Status score < 80, the number of chemotherapy cycles <4, hemoglobin level ≤120 g/L, the count of neutrophils greater than 5.8 ×109/L, and the count of platelets greater than 220 ×109/L independently predicted worse OS. According to the number of risk factors, patients were further divided into one of three risk groups: those having ≤ 2 risk factors were scored as the low-risk group, those having 3 risk factors were scored as the moderate-risk group, and those having ≥ 4 risk factors were scored as the high-risk group. In the low-risk group, 1-year OS is 67.7%, 2-year OS is 32.1%, and 3-year OS is 19.3%; in the moderate-risk group, 1-year OS is 59.6%, 2-year OS is 18.0%, and 3-year OS is 7.9%; the corresponding OS rates for the high-risk group were 26.2%, 7.9%, and 0% (P<0.001) respectively.ConclusionMetastatic NSCLC patients treated with chemotherapy in combination with thoracic radiation may be classified as low-risk, moderate-risk, or high-risk group using six independent prognostic factors. This prognostic model may help design the study and develop the plans of individualized treatment.

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A nomogram with lymph node status predicts survival and the benefit of postoperative adjuvant therapy in IIIA-N2 Non-small cell lung cancer patients after surgery

10.21203/rs.3.rs-98065/v2 ◽

2020 ◽

Author(s):

Ye Chen ◽

Lei Dong ◽

Minjing Li ◽

Fei He ◽

ChenHui Qiu ◽

...

Keyword(s):

High Risk ◽

Lymph Nodes ◽

Survival Benefit ◽

Risk Group ◽

High Risk Group ◽

Small Cell ◽

Low Risk ◽

Small Cell Lung ◽

Moderate Risk ◽

Nsclc Patients

Abstract Objective: This study aimed at establishing a novel nomogram predicting overall survival and investigating the survival benefit of various postoperative adjuvant treatments (POAT) in IIIA-N2 Non-small cell lung cancer (NSCLC) patients after surgery.Methods: Data of IIIA-N2 NSCLC patients between 2004 and 2016 were collected from the Surveillance, Epidemiology, and End Results (SEER). Patients were excluded if the information regarding follow-up time and clinicopathological features were incomplete. Through Univariate and multivariate analyses, independent prognostic factors were identified and integrated into the construction of nomogram. The survival benefit of POAT was evaluated in model-defined low-risk, intermediate-risk, and high-risk subgroups, respectively.Results: In total, 4389 patients were finally included for analysis. Patients’ age, sex, T stage, differentiation grade, examined lymph nodes number (ELN), metastatic lymph nodes number (MLN), and metastatic lymph nodes ratio (LNR) were identified as independent prognostic factors and were integrated into the construction of nomogram. The C-index and calibration curves indicated that the predictive performance of the nomogram was satisfactory. Patients were then categorized into three prognostic groups with the increasing risk of all-cause of death. The prognosis of patients receiving POAT (POCT or PORT plus POCT) and patients receiving surgery alone was comparable in low-risk group, while POCT could significantly prolong survival for IIIA-N2 NSCLC patients after surgery in moderate-risk and high-risk groups. Only patients in high-risk group could benefit from the combination of postoperative radiotherapy (PORT) and postoperative chemotherapy (POCT).Conclusion: In this large-cohort retrospective study, A survival-predicting nomogram and risk stratification model were established to estimate prognosis in IIIA-N2 NSCLC patients. Surgery alone was recommended as the first choice of treatment to patients in low-risk group. POCT was recommended for patients in moderate-risk group, and the combination of PORT and POCT was recommended for patients in high-risk group. This study may provide additional integration, introspection, and improvement for therapeutic decision-making.

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Enteropathy-Associated T-Cell Lymphoma: a Clinical Prognostic Model to Identify High Risk Patients

Blood ◽

10.1182/blood.v116.21.3092.3092 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3092-3092

Author(s):

Laura R de Baaij ◽

Jolanda MW van de Water ◽

Wieke HM Verbeek ◽

Otto J Visser ◽

Dirk J Kuik ◽

...

Keyword(s):

Risk Factors ◽

T Cell ◽

High Risk ◽

Prognostic Model ◽

Cell Lymphoma ◽

Risk Group ◽

High Risk Group ◽

Low Risk ◽

T Cell Lymphoma ◽

Risk Patients

Abstract Abstract 3092 Enteropathy-associated T-cell lymphoma (EATL) is a rare intestinal lymphoma that arises from intraepithelial lymphocytes. In Western countries EATL accounts for 5% of all gastrointestinal lymphomas and in 80–90% of all cases this lymphoma is associated with celiac disease (CD). Based on clinical presentation, EATL can be divided into two subtypes: primary and secondary EATL. Primary EATL develops without a preceding history of CD. The first presentation is often perforation or obstruction, which leads to diagnosis of both EATL and CD. Secondary EATL is diagnosed in patients with well-established CD or refractory CD. These patients deteriorate and eventually develop EATL. The current standard treatment for both types of EATL consists of surgery and chemotherapy, but overall survival (OS) is poor and new therapeutic strategies are urgently needed. For risk-based selection of patients for new therapies and clinical trials, prognostic models as the International Prognostic Index (IPI) are generally used. Since IPI is not predictive for EATL, we determined a prognostic model specifically for EATL, which can identify high-risk patients who need more aggressive therapy. Forty-one patients were diagnosed with EATL and retrospectively analyzed. Two- and 5-years OS were 18% and 10% respectively (range: 0 – 97 months). In multivariate analysis, 3 risk factors were predictive for survival: serum LDH > normal (P < 0.001; RR 6.65; 95% CI 1.96 to 9.89), presence of B-symptoms (P < 0.001; RR 4.41; 95% CI 2.73 to 16.18) and subtype secondary EATL (P = 0.036; RR 2.33; 95% CI 1.06 to 5.13). A weighted point score was assigned to each of these 3 factors and a prognostic model was constructed. Four risk groups were identified (P < 0.0001). Group I showed most favorable outcome: 2- and 5-years OS were 55% and 30% respectively. Although survival rates in groups II, III and IV were significantly different, in none of these groups 2-years survival was achieved. Therefore, the model was simplified to a low risk and a high risk group (P < 0.0001, Figure 1). The low risk group represented patients with no risk factors, i.e. primary EATL with no B-symptoms and normal LDH. In the high risk group, patients had 1 or more of the risk factors elevated serum LDH, B-symptoms or subtype secondary EATL. The new prognostic model showed superior predictive capacity as compared to IPI. In conclusion, our new prognostic model clearly identifies a high and a low risk group. Patients with one or more of the risk factors serum LDH > normal, B-symptoms or subtype secondary EATL are at high risk, and therefore new therapies for this group are urgently needed. Figure 1: Survival in EATL. Low risk group = no risk factors. High risk group = presence of 1 or more of the following risk factors: serum LDH > normal, B-symptoms or subtype secondary EATL. Figure 1:. Survival in EATL. Low risk group = no risk factors. High risk group = presence of 1 or more of the following risk factors: serum LDH > normal, B-symptoms or subtype secondary EATL. Disclosures: No relevant conflicts of interest to declare.

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Abstract TP387: Abcd 2 Score Predicts The Long-term Risk Of Stroke After Transient Ischemic Attack: Fukuoka Stroke Registry

Stroke ◽

10.1161/str.44.suppl_1.atp387 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Yasuhiro Kumai ◽

Takuya Kiyohara ◽

Masahiro Kamouchi ◽

Sohei Yoshimura ◽

Hiroshi Sugimori ◽

...

Keyword(s):

High Risk ◽

Transient Ischemic Attack ◽

Risk Group ◽

High Risk Group ◽

Low Risk ◽

Rank Test ◽

Moderate Risk ◽

Stroke Registry ◽

Ischemic Attack

Background and Purpose— ABCD 2 score has been developed to predict the early risk of stroke after transient ischemic attack (TIA). The aim of this study was to clarify whether ABCD 2 score predicts the occurrence of stroke in the long term after TIA. Methods— Fukuoka Stroke Registry (FSR) is a multicenter epidemiological study database on acute stoke. From June 2007 to June 2011, 496 (305 males, 70 ± 13 years of age) patients who had suffered from TIA and were hospitalized in the 7 stroke centers within 7 days after the onset of TIA were enrolled in this study. The patients were divided into three groups according to the risk: low-risk (ABCD 2 score 0-3; n=72), moderate-risk (4-5; n=229) and high-risk group (6-7; n=195). They were followed up prospectively for up to 3 years. Cox proportional hazard regression model was used to elucidate whether ABCD 2 score was a predictor for stroke after TIA after adjusting for confounding factors. Results— Among three groups, there were significant differences in age, hypertension, diabetes mellitus and the decrease in estimated glomerular filtration rate (P<0.01, significantly). During a mean follow-up of 1.3 years, Kaplan-Meier analysis demonstrated that the stroke rate in TIA patients was significantly lower in low-risk group than in moderate-risk or high-risk group (log rank test, p<0.001). The adjusted hazard ratios for stroke in patients with TIA increased with moderate-risk group (Hazard ratio [HR]: 3.47, 95% CI: 1.03-21.66, P<0.05) and high-risk group (HR: 4.46, 95% CI: 1.31-27.85, P<0.05), compared to low-risk group. Conclusions— The ABCD 2 score is able to predict the long-term risk of stroke after TIA.

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Oncologic Outcomes After Adjuvant Radiotherapy for Stage II Endometrial Carcinoma: A Korean Radiation Oncology Group Study (KROG 14–10)

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001030 ◽

2017 ◽

Vol 27 (7) ◽

pp. 1387-1392 ◽

Cited By ~ 3

Author(s):

Jinhong Jung ◽

Young Seok Kim ◽

Ji Hyeon Joo ◽

Won Park ◽

Jong-Hoon Lee ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Radiation Oncology ◽

Adjuvant Radiotherapy ◽

Lymphovascular Invasion ◽

Risk Group ◽

High Risk Group ◽

Low Risk ◽

Median Dose ◽

Radiation Oncology Group

ObjectiveThe aim of this study was to investigate the survival, patterns of failure, and prognostic factors in patients with stage II endometrial carcinoma treated with adjuvant radiotherapy.MethodsWe reviewed the medical records of patients who underwent total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection followed by adjuvant radiotherapy in 10 participating hospitals of the Korean Radiation Oncology Group. Most patients received adjuvant external beam radiation therapy, with a median dose of 50.4 Gy; approximately 50% of these patients received an additional brachytherapy boost, with a median dose of 18 Gy. Adjuvant chemotherapy was administered to 19 patients.ResultsA total of 122 patients were examined. Over a median follow-up period of 62.7 months (range, 1.9–158.8 months), the 5-year overall survival (OS) and disease-free survival rates were found to be 91.1% and 85.1%, respectively. Recurrence was observed in 14 patients (11.5%), including 3 with local recurrence and 11 with distant metastases as the first site of recurrence. Univariate analysis indicated that lymphovascular invasion was related to an unfavorable OS. An age of 60 years or above, histologic grade 3, and lymphovascular invasion were identified as risk factors for OS. Because there were several risk factors related to OS, we assigned patients to a high-risk group (defined as cases with ≥1 risk factors) and a low-risk group. The 5-year OS rate of the high-risk group was significantly inferior to that of the low-risk group (82.9% vs 100%, P = 0.003).ConclusionsThe high-risk group had a significantly poorer survival rate than the low-risk group, and distant metastasis was the main pattern of recurrence, thus indicating that further adjuvant chemotherapy should be considered in high-risk patients.

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Development and Validation of a Novel Hypoxia-Related Long Noncoding RNA Model With Regard to Prognosis and Immune Features in Breast Cancer

Frontiers in Cell and Developmental Biology ◽

10.3389/fcell.2021.796729 ◽

2021 ◽

Vol 9 ◽

Author(s):

Peng Gu ◽

Lei Zhang ◽

Ruitao Wang ◽

Wentao Ding ◽

Wei Wang ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

Long Noncoding Rna ◽

Noncoding Rna ◽

Prognostic Model ◽

Cox Regression ◽

Risk Group ◽

High Risk Group ◽

Low Risk ◽

Cox Regression Analysis

Background: Female breast cancer is currently the most frequently diagnosed cancer in the world. This study aimed to develop and validate a novel hypoxia-related long noncoding RNA (HRL) prognostic model for predicting the overall survival (OS) of patients with breast cancer.Methods: The gene expression profiles were downloaded from The Cancer Genome Atlas (TCGA) database. A total of 200 hypoxia-related mRNAs were obtained from the Molecular Signatures Database. The co-expression analysis between differentially expressed hypoxia-related mRNAs and lncRNAs based on Spearman’s rank correlation was performed to screen out 166 HRLs. Based on univariate Cox regression and least absolute shrinkage and selection operator Cox regression analysis in the training set, we filtered out 12 optimal prognostic hypoxia-related lncRNAs (PHRLs) to develop a prognostic model. Kaplan–Meier survival analysis, receiver operating characteristic curves, area under the curve, and univariate and multivariate Cox regression analyses were used to test the predictive ability of the risk model in the training, testing, and total sets.Results: A 12-HRL prognostic model was developed to predict the survival outcome of patients with breast cancer. Patients in the high-risk group had significantly shorter median OS, DFS (disease-free survival), and predicted lower chemosensitivity (paclitaxel, docetaxel) compared with those in the low-risk group. Also, the risk score based on the expression of the 12 HRLs acted as an independent prognostic factor. The immune cell infiltration analysis revealed that the immune scores of patients in the high-risk group were lower than those of the patients in the low-risk group. RT-qPCR assays were conducted to verify the expression of the 12 PHRLs in breast cancer tissues and cell lines.Conclusion: Our study uncovered dozens of potential prognostic biomarkers and therapeutic targets related to the hypoxia signaling pathway in breast cancer.

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Development and validation of a ferroptosis-related prognostic model in pancreatic cancer

10.21203/rs.3.rs-139597/v2 ◽

2021 ◽

Author(s):

Chen-jie Qiu ◽

Xue-bing Wang ◽

Zi-ruo Zheng ◽

Chao-zhi Yang ◽

Kai Lin ◽

...

Keyword(s):

Pancreatic Cancer ◽

T Cell ◽

High Risk ◽

Risk Score ◽

Prognostic Model ◽

Immune Cell ◽

Risk Group ◽

High Risk Group ◽

Low Risk ◽

Immune Cell Infiltration

Abstract Background: The purpose of this study was to identify ferroptosis-related genes (FRGs) associated with the prognosis of pancreatic cancer and to construct a prognostic model based on FRGs. Methods: Based on pancreatic cancer data obtained from The Cancer Genome Atlas database, we established the prognostic model from 232 FRGs. A nomogram was constructed by combining the prognostic model and clinicopathological features. Gene Expression Omnibus datasets and tissue samples obtained from our center were utilized to validate the model. Relationship between risk score and immune cell infiltration was explored by CIBERSORT and TIMER.Results: The prognostic model was established based on four FRGs (ENPP2, ATG4D, SLC2A1 and MAP3K5) and can be an independent risk factor in pancreatic cancer (HR 1.648, 95% CI 1.335-2.035, p < 0.001). Based on the median risk score, patients were divided into a high-risk group and a low-risk group. The prognosis of the low-risk group was significantly better than that of the high-risk group. In the high-risk group, patients treated with chemotherapy had a better prognosis. The nomogram showed that the model was the most important element. Gene set enrichment analysis identified three key pathways, namely, TGFβ signaling, HIF signaling pathway and adherens junction. The prognostic model can also affect the immune cell infiltration, such as macrophages M0, M1, CD4+T cell and CD8+T cell. Conclusion: A ferroptosis-related prognostic model can be employed to predict the prognosis of pancreatic cancer. Ferroptosis can be an important marker and immunotherapy can be a potential therapeutic target for pancreatic cancer.

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Risk scoring model to predict recurrence in locally advanced breast cancer (LABC) treated with neoadjuvant chemotherapy (NACT).

Journal of Global Oncology ◽

10.1200/jgo.2019.5.suppl.98 ◽

2019 ◽

Vol 5 (suppl) ◽

pp. 98-98

Author(s):

Sushma Agrawal ◽

Prabhakar Mishra ◽

Punita Lal ◽

Gaurav Agarwal ◽

Amit Agarwal ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Risk Group ◽

Locally Advanced ◽

High Risk Group ◽

Low Risk ◽

Scoring Model ◽

Group Score ◽

Risk Scoring ◽

Independent Risk Factors

98 Background: Complete response (CR) to NACT portends favorable long term outcomes in LABC. There is a need for a tool to risk categorise patients for recurrence risk (RR), so that intensification of treatment can be offered to women with high risk of recurrence. Methods: A prospectively maintained database of LABC (between January 2007 to December 2012), who received NACT followed by definitive surgery, radiotherapy and endocrine therapy in endocrine sensitive disease was retrospectively analyzed for clinico-pathological and treatment factors affecting disease free survival (DFS). A risk scoring model was developed on the basis of beta coefficients of identified independent risk factors for DFS. Results: The incidence of loco-regional relapse was 8% and that of distant metastases was 32% in a dataset of 206 patients at a median follow-up of 47 months (IQR 24-62 mo). The independent risk factors for recurrence were index T stage [HR 1.8 (0.9-3.6)], N stage [HR 1.7 (0.4 – 4.7)], grade [HR 1.8 (0.8-4.2)], age less than and more than 40 years [HR 1.6 (0.4-0.9)], pathologic CR [HR 4.3 (1.7- 10.7)], intrinsic subtype [HR 2.2 (1.3-3.7)], and type of surgery (BCS vs MRM) [HR 2.2 (1.3-3.6)]. The ROC of the model for the prediction of recurrence was 0.67 (95 % CI: 0.61-0.75). The results of this model were validated by dividing the population into 3 risk groups: low risk (score less than 12), intermediate risk group (score between 13-15), high risk group (score 16 or more). The chances of recurrence are 16% versus 34% versus 57% in low, intermediate and high risk group respectively. Presence of three risk factors implies low risk, five intermediate and more than five high risk. Conclusions: The risk scoring model developed by us predicts RR and can be used for selecting patients for treatment intensification in high risk category.

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Prospective study using Apache II scoring to predict the outcomes of patients undergoing emergency gastrointestinal procedure

International Surgery Journal ◽

10.18203/2349-2902.isj20213595 ◽

2021 ◽

Vol 8 (9) ◽

pp. 2680

Author(s):

Vaishali C. Shelgaonkar ◽

Swatika P. Butey ◽

Vishal R. Nandagawali

Keyword(s):

High Risk ◽

Risk Group ◽

High Risk Group ◽

Low Risk ◽

Apache Ii ◽

Morbidity And Mortality ◽

Surgical Intensive Care Unit ◽

Apache Ii Score ◽

Care Hospital ◽

Moderate Risk

Background: Many scoring systems have been used to assess the morbidity and mortality of patients presenting with acute abdomen, of which Apache II (acute physiology and chronic health evaluation) score has been accepted widely. This study predicted the effectiveness of Apache II scoring system as a potential clinical and research tool which could be included as routine part of patient assessment to predict the morbidity and mortality in patients undergoing emergency gastrointestinal procedures.Methods: This study was conducted in the surgical intensive care unit of our tertiary care hospital. It was a prospective observational study done over a period of one year where we assessed the efficacy of Apache II score in eighty two patients.Results: The Apache II scores were divided into three categories, 0-15 low risk group, 16-30 moderate risk group and 31-45 high risk group. There were 25 patients in the low risk group with all being satisfactorily discharged. With 44 patients in the moderate risk group 13 expired (29.54% mortality) and out of 13 patients in the high risk group 11 patients died (84.61% mortality).Conclusions: In the present study the APACHE II scores have correlated well with the outcomes and ICU stay of the patient groups.

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A 5-Gene Signature Is Closely Related to Tumor Immune Microenvironment and Predicts the Prognosis of Patients with Non-Small Cell Lung Cancer

BioMed Research International ◽

10.1155/2020/2147397 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Jia Li ◽

Huiyu Wang ◽

Zhaoyan Li ◽

Chenyue Zhang ◽

Chenxing Zhang ◽

...

Keyword(s):

Gene Expression ◽

High Risk ◽

Risk Group ◽

Gene Signature ◽

High Risk Group ◽

Low Risk ◽

Egfr Mutations ◽

Kaplan Meier ◽

Tumor Immune Microenvironment ◽

Nsclc Patients

Purpose. Establishing prognostic gene signature to predict clinical outcomes and guide individualized adjuvant therapy is necessary. Here, we aim to establish the prognostic efficacy of a gene signature that is closely related to tumor immune microenvironment (TIME). Methods and Results. There are 13,035 gene expression profiles from 130 tumor samples of the non-small cell lung cancer (NSCLC) in the data set GSE103584. A 5-gene signature was identified by using univariate survival analysis and Least Absolute Shrinkage and Selection Operator (LASSO) to build risk models. Then, we used the CIBERSORT method to quantify the relative levels of different immune cell types in complex gene expression mixtures. It was found that the ratio of dendritic cells (DCs) activated and mast cells (MCs) resting in the low-risk group was higher than that in the high-risk group, and the difference was statistically significant (P<0.001 and P=0.03). Pathway enrichment results which were obtained by performing Gene Set Variation Analysis (GSVA) showed that the high-risk group identified by the 5-gene signature had metastatic-related gene expression, resulting in lower survival rates. Kaplan–Meier survival results showed that patients of the high-risk group had shorter disease-free survival (DFS) and overall survival (OS) than those of the low-risk group in the training set (P=0.0012 and P<0.001). The sensitivity and specificity of the gene signature were better and more sensitive to prognosis than TNM (tumor/lymph node/metastasis) staging, in spite of being not statistically significant (P=0.154). Furthermore, Kaplan–Meier survival showed that patients of the high-risk group had shorter OS and PFS than those of the low-risk group (P=0.0035, P<0.001, and P<0.001) in the validating set (GSE31210, GSE41271, and TCGA). At last, univariate and multivariate Cox proportional hazard regression analyses were used to evaluate independent prognostic factors associated with survival, and the gene signature, lymphovascular invasion, pleural invasion, chemotherapy, and radiation were employed as covariates. The 5-gene signature was identified as an independent predictor of patient survival in the presence of clinical parameters in univariate and multivariate analyses (P<0.001) (hazard ratio (HR): 3.93, 95% confidence interval CI (2.17–7.1), P=0.001, (HR) 5.18, 95% CI (2.6995–9.945), P<0.001), respectively. Our 5-gene signature was also related to EGFR mutations (P=0.0111), and EGFR mutations were mainly enriched in low-risk group, indicating that EGFR mutations affect the survival rate of patients. Conclusion. The 5-gene signature is a powerful and independent predictor that could predict the prognosis of NSCLC patients. In addition, our gene signature is correlated with TIME parameters, such as DCs activated and MCs resting. Our findings suggest that the 5-gene signature closely related to TIME could predict the prognosis of NSCLC patients and provide some reference for immunotherapy.

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Central nervous system relapse in malignant lymphomas: risk factors and implications for prophylaxis

Blood ◽

10.1182/blood.v54.6.1249.1249 ◽

1979 ◽

Vol 54 (6) ◽

pp. 1249-1257 ◽

Cited By ~ 90

Author(s):

JP Litam ◽

F Cabanillas ◽

TL Smith ◽

GP Bodey ◽

EJ Freireich

Keyword(s):

Risk Factors ◽

Central Nervous System ◽

Nervous System ◽

High Risk ◽

Malignant Lymphoma ◽

Risk Group ◽

High Risk Group ◽

Low Risk ◽

Central Nervous System Relapse ◽

Cns Relapse

Abstract The records of 292 patients with malignant lymphoma other than Hodgkin's disease, registered in our protocols from 1967 to 1977, were reviewed to identify those with central nervous system (CNS) involvement. Thirty-one patients were encountered with this complication, an incidence of 11%. Patients with a diffuse histology had a higher frequency of CNS recurences (27/174 = 16%) in contrast to only 4/118 (3%) for those with nodular types. However, if only patients with diffuse histology in CR are considered, the frequency of CNS relapse is 13.5% (13/98). The risk factors that predict for the development of this complication were studied using multivariate analysis. Diffuse poorly differentiated lymphocytic and diffuse undifferentiated lymphomas were found to be associated with a high risk of CNS relapse. Prior chemotherapy, bone marrow involvement, age less than 35, and extranodal disease were also identified as high-risk factors. Using the information generated by a logistic regression model, patients with malignant lymphoma of diffuse type can be classified into three categories when first seen: low-risk group, intermediate, and high-risk group. CNS prophylaxis is recommended for the intermediate and high-risk group, while only close follow-up is advised for the low-risk group patients who have one adverse characteristic.

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