Risk Stratification for Diffuse Large B-Cell Lymphoma by Integrating Interim Evaluation and International Prognostic Index: A Multicenter Retrospective Study

The baseline International Prognostic Index (IPI) is not sufficient for the initial risk stratification of patients with diffuse large B-cell lymphoma (DLBCL) treated with R‐CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone). The aims of this study were to evaluate the prognostic relevance of early risk stratification in DLBCL and develop a new stratification system that combines an interim evaluation and IPI. This multicenter retrospective study enrolled 314 newly diagnosed DLBCL patients with baseline and interim evaluations. All patients were treated with R-CHOP or R-CHOP-like regimens as the first-line therapy. Survival differences were evaluated for different risk stratification systems including the IPI, interim evaluation, and the combined system. When stratified by IPI, the high-intermediate and high-risk groups presented overlapping survival curves with no significant differences, and the high-risk group still had >50% of 3-year overall survival (OS). The interim evaluation can also stratify patients into three groups, as 3-year OS and progression-free survival (PFS) rates in patients with stable disease (SD) and progressive disease (PD) were not significantly different. The SD and PD patients had significantly lower 3-year OS and PFS rates than complete remission and partial response patients, but the percentage of these patients was only ~10%. The IPI and interim evaluation combined risk stratification system separated the patients into low-, intermediate-, high-, and very high-risk groups. The 3-year OS rates were 96.4%, 86.7%, 46.4%, and 40%, while the 3-year PFS rates were 87.1%, 71.5%, 42.5%, and 7.2%. The OS comparison between the high-risk group and very high-risk group was marginally significant, and OS and PFS comparisons between any other two groups were significantly different. This combined risk stratification system could be a useful tool for the prognostic prediction of DLBCL patients.

Download Full-text

Clinical Prognostic Models in Diffuse Large B-Cell Lymphoma Patients Are Still Essential in the Rituximab Era

Blood ◽

10.1182/blood.v124.21.3057.3057 ◽

2014 ◽

Vol 124 (21) ◽

pp. 3057-3057

Author(s):

Luis Alberto de Padua Covas Lage ◽

Renata Oliveira Costa ◽

Abrahão Elias Hallack Neto ◽

Sheila Siqueira ◽

Rodrigo Santucci ◽

...

Keyword(s):

High Risk ◽

Risk Group ◽

International Prognostic Index ◽

Prognostic Index ◽

B Cell Lymphoma ◽

High Risk Group ◽

Intermediate Risk ◽

Risk Patients ◽

Risk Categories

Abstract Introduction: To evaluate a new enhanced IPI proposed by the National Comprehensive Cancer Network (NCCN-IPI) in DLBCL patients, we compared the international prognostic index (IPI), R-IPI and NCCN-IPI in DLBCL patients treated with rituximab, cyclophosphamide, hidroxydaunorubicin, vincristine and prednisone (R-CHOP). Methods: From June 2008 to November 2011 we retrospectively evaluated 146 DLBCL patients treated with R-CHOP-21 referred for cancer treatment in a single university institution in Brazil. Patient's clinical data were assessed to calculate the IPI, R-IPI and NCCN-IPI. Results: Patient's median age was 58.9 years (range 16 – 86); 85 (57.8%) were female. According to IPI, risk categories were low (n=41, 28.1%), low-intermediate (n=43, 29.5%), high-intermediate (n=37, 25.3%) and high (n=25, 17.1%). Using R-IPI, risk categories were very good (n=19, 13%), good (n=65, 44.5%) and poor (n=62, 42.5%). According to NCCN-IPI, risk categories were low (n=12, 8.2%), low-intermediate (n=52, 35.6%), high-intermediate (n=62, 42.5%) and high (n=20, 13.7%). At 30 months (median follow up 17.7 months - range 0.6-58.2 months) the overall survival (OS) was 75.5%. The progression-free survival (PFS) at a median follow-up of 16.3 months (range 0.6-52.4) was 68.3% for all patients. Using IPI, the OS at 30 months did not differ between low and low-intermediate risk patients (96.8% vs. 82.2%; p=0.136); however, it was higher than the OS of high-intermediate risk (n=37; 96.8% vs 74.1% p=0.11) and high-risk (n=25; 96.8% vs 41% p < 0.001) patients (Figure 1). The NCCN-IPI demonstrated significant differences in OS (p < 0,001) and PFS (p<0.001) among low-intermediate, high-intermediate, and high risk groups, with the high-risk group exhibiting worse OS (32.1% in 30 months) (Figure 2). According to IPI, the OS in high-risk patients was 41%. Figure 1: OS and PFS according to International Prognostic Index (IPI) Figure 1:. OS and PFS according to International Prognostic Index (IPI) Figure 2: OS and PFS according to NCCN-IPI Figure 2:. OS and PFS according to NCCN-IPI Figure 3 Figure 3. Conclusion: In our study the NCCN-IPI, but not the IPI or R-IPI was able to discriminate a high-risk group of DLBCL patients treated with R-CHOP with worse OS. Disclosures No relevant conflicts of interest to declare.

Download Full-text

The clinical features and prognosis of 31 HIV-infected diffuse large B-cell lymphoma cases

Science Progress ◽

10.1177/00368504211022500 ◽

2021 ◽

Vol 104 (2) ◽

pp. 003685042110225

Author(s):

Yun Lian ◽

Jiayu Huang ◽

Huihui Zhao

Keyword(s):

High Risk ◽

B Cell ◽

Cell Lymphoma ◽

Risk Group ◽

International Prognostic Index ◽

Prognostic Index ◽

B Cell Lymphoma ◽

Standard Chemotherapy ◽

Large B Cell Lymphoma ◽

Large B Cell

This retrospective study was designed to describe the clinical characteristics and prognosis of human immunodeficiency virus (HIV)-infected diffuse large B-cell lymphoma (DLBCL) patients. We retrospectively enrolled 31 patients newly diagnosed with HIV-infected DLBCL from 2009 to 2019 in our institution. The median age of patients was 47 years, and most patients were male ( n = 27, 87.1%). Baseline mean CD4+ count was 150.72 ± 146.57/μl. Eighteen (58.1%) patients had B symptoms. Categorized by international prognostic index (IPI) score, 7 cases (22.6%) were in low-risk group (IPI 0-1) and 24 cases (77.4%) were in medium-high risk group (IPI 2-5). Twenty-five (80.6%) patients received highly active antiretroviral therapy (HAART) and 16 (51.6%) underwent standard chemotherapy. The mortality rate was 58.1% (18/31). Univariate survival analysis revealed that HCV infection ( p = 0.032), standard chemotherapy treatments ( p = 0.038) were associated with overall survival (OS). Our results showed that HIV-infected DLBCL patients had high-risk stratification and high mortality. HCV-coinfection might be associated with poor OS. Early diagnosis and standardized treatments might be beneficial for promoting the survival of HIV-infected DLBCL patients.

Download Full-text

Validation of the Mantle Cell Lymphoma Prognostic Index (MIPI): A Valuable Tool for Risk Stratification in Mantle Cell Lymphoma.

Blood ◽

10.1182/blood.v114.22.2703.2703 ◽

2009 ◽

Vol 114 (22) ◽

pp. 2703-2703

Author(s):

Stephen Douglas Smith ◽

Eric D. Hsi ◽

Brian J. Bolwell ◽

Amanda Maggiotto ◽

Meagan Effinger ◽

...

Keyword(s):

High Risk ◽

Risk Stratification ◽

Mantle Cell Lymphoma ◽

Cell Lymphoma ◽

Performance Status ◽

International Prognostic Index ◽

Prognostic Index ◽

High Risk Group ◽

Ecog Performance Status ◽

Mantle Cell

Abstract Abstract 2703 Poster Board II-679 Introduction: Mantle cell lymphoma (MCL) is an incurable disease with a highly variable course. Improvements in therapy have been impeded by the lack of a universal prognostic model, making risk stratification and comparisons across clinical trials difficult. The International Prognostic Index (IPI) and Follicular Lymphoma International Prognostic Index (FLIPI) have been applied but show limitations in MCL, especially in distinguishing low and intermediate-risk patients (pts). The MIPI (Mantle Cell International Prognostic Index) was developed to overcome these limitations, and is based on WBC, age, and LDH (analyzed as continuous variables) and ECOG performance status.1 However, the MIPI has yet to be independently validated, and failed to predict outcome of MCL pts treated with Hyper-CVAD.2 To examine the prognostic capacity of the MIPI, we reviewed outcomes of pts diagnosed with MCL from 1998–2008 at the Cleveland Clinic Taussig Cancer Institute (CCTCI). Methods: Cases of MCL diagnosed at CCTCI were identified from our pathology database, yielding 85 unique pts. These subjects were retrospectively analyzed with approval of our Institutional Review Board. A total of 48 pts with advanced stage disease who underwent immediate treatment (within 90 days of diagnosis), and for whom adequate data for assignment of both MIPI and IPI existed, were the subject of review. Survival was identified from medical records and confirmed using a public social security database. Outcomes were compared using log-rank analysis of Kaplan-Meier survival analyses, and MIPI was calculated in accordance with the initial publication.1 Results: Pt characteristics at diagnosis were: median age 62 (range 39–85), 73% male, 75% ECOG performance status of 0-1, 96% stage IV disease, 52% elevated LDH, and 40% had extranodal involvement other than bone marrow (23% with GI involvement). Six pts had the blastoid variant of MCL. IPI scores at diagnosis were as follows: low (17%)/ low-intermediate (31%)/ high-int (25%)/ high (27%). MIPI scores at diagnosis were: low (33%) / int (25%)/ high(42%). Initial treatment included an anthracycline in 71% and rituximab in 60%. HyperCVAD was given 33%, and 23% underwent upfront (CR1/PR1) autologous transplantation. Median follow-up of survivors is 5.7 years. Median OS and RFS for all pts is 3.9 and 2.5 years, respectively. The IPI distinguished low and high-risk groups, but low-int and high-int groups were closely approximated (Figure 1). On the other hand, the MIPI distinguished 3 separate groups (Figure 2), including a high risk group with a 5-year survival of 11%. The MIPI maintained its prognostic capacity even in HyperCVAD-treated pts (log rank p=.01 for low/int/high MIPI among 16 pts, figure not shown.) The use of regimens including rituximab was not associated with improved OS (log rank p=0.21, comparing rituximab at any time vs none, figure not shown). Conclusions: Based on long-term follow-up of 48 pts diagnosed with MCL at CCTCI from 1998–2008, we verified the accuracy and ease of application of the MIPI for determining prognosis in MCL. On further analysis, rituximab did not impact OS of MCL pts. Clinical trials in MCL should employ the MIPI as a risk-stratification tool, and novel approaches are urgently needed for pts in the high-risk group. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

CNS International Prognostic Index: A Risk Model for CNS Relapse in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP

Journal of Clinical Oncology ◽

10.1200/jco.2015.65.6520 ◽

2016 ◽

Vol 34 (26) ◽

pp. 3150-3156 ◽

Cited By ~ 115

Author(s):

Norbert Schmitz ◽

Samira Zeynalova ◽

Maike Nickelsen ◽

Roopesh Kansara ◽

Diego Villa ◽

...

Keyword(s):

High Risk ◽

B Cell ◽

Risk Model ◽

Risk Group ◽

International Prognostic Index ◽

Prognostic Index ◽

B Cell Lymphoma ◽

Intermediate Risk ◽

Data Set ◽

Cns Relapse

Purpose To develop and validate a risk score for relapse in the CNS in patients with diffuse large B-cell lymphoma (DLBCL). Patients and Methods A total of 2,164 patients (18 to 80 years old) with aggressive B-cell lymphomas (80% DLBCL) treated with rituximab and CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)-like chemotherapy, who were enrolled in studies from the German High-Grade Non-Hodgkin Lymphoma Study Group and the MabThera International Trial, were analyzed for occurrence of relapse/progression in the CNS. The resulting risk model was validated in an independent data set of 1,597 patients with DLBCL identified in the British Columbia Cancer Agency Lymphoid Cancer database. Results The risk model consists of the International Prognostic Index (IPI) factors in addition to involvement of kidneys and/or adrenal glands (CNS-IPI). In a three-risk group model, the low-risk group (46% of all patients analyzed), the intermediate-risk group (41%), and the high-risk group (12%) showed 2-year rates of CNS disease of 0.6% (CI, 0% to 1.2%), 3.4% (CI, 2.2% to 4.4%), and 10.2% (CI, 6.3% to 14.1%), respectively. Patients from the validation British Columbia Cancer Agency data set showed similar rates of CNS disease for low-risk (0.8%; CI, 0.0% to 1.6%), intermediate-risk (3.9%; CI, 2.3% to 5.5%), and high-risk (12.0%; CI, 7.9% to 16.1%) groups. Conclusion The CNS-IPI is a robust, highly reproducible tool that can be used to estimate the risk of CNS relapse/progression in patients with DLBCL treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy. Close to 90% of patients with DLBCL belong to the low- and intermediate-risk groups and have a CNS relapse risk < 5%; they may be spared any diagnostic and therapeutic intervention. In contrast, those in the high-risk group have a > 10% risk of CNS relapse and should be considered for CNS-directed investigations and prophylactic interventions.

Download Full-text

IVIM Parameters on MRI Could Predict ISUP Risk Groups of Prostate Cancers on Radical Prostatectomy

Frontiers in Oncology ◽

10.3389/fonc.2021.659014 ◽

2021 ◽

Vol 11 ◽

Author(s):

Chun-Bi Chang ◽

Yu-Chun Lin ◽

Yon-Cheong Wong ◽

Shin-Nan Lin ◽

Chien-Yuan Lin ◽

...

Keyword(s):

High Risk ◽

Radical Prostatectomy ◽

Risk Stratification ◽

Risk Group ◽

Area Under The Curve ◽

Region Of Interest ◽

Risk Groups ◽

High Risk Group ◽

Multivariable Logistic Regression Analysis ◽

Perfusion Fraction

PurposeTo elucidate the usefulness of intravoxel incoherent motion (IVIM)/apparent diffusion coefficient (ADC) parameters in preoperative risk stratification using International Society of Urological Pathology (ISUP) grades.Materials and MethodsForty-five prostate cancer (PCa) patients undergoing radical prostatectomy (RP) after prostate multiparametric magnetic resonance imaging (mpMRI) were included. The ISUP grades were categorized into low-risk (I-II) and high-risk (III-V) groups, and the concordance between the preoperative and postoperative grades was analyzed. The largest region of interest (ROI) of the dominant tumor on each IVIM/ADC image was delineated to obtain its histogram values (i.e., minimum, mean, and kurtosis) of diffusivity (D), pseudodiffusivity (D*), perfusion fraction (PF), and ADC. Multivariable logistic regression analysis of the IVIM/ADC parameters without and with preoperative ISUP grades were performed to identify predictors for the postoperative high-risk group.ResultsThirty-two (71.1%) of 45 patients had concordant preoperative and postoperative ISUP grades. Dmean, D*kurtosis, PFkurtosis, ADCmin, and ADCmean were significantly associated with the postoperative ISUP risk group (all p < 0.05). Dmean and D*kurtosis (model I, both p < 0.05) could predict the postoperative ISUP high-risk group with an area under the curve (AUC) of 0.842 and a 95% confidence interval (CI) of 0.726–0.958. The addition of D*kurtosis to the preoperative ISUP grade (model II) may enhance prediction performance, with an AUC of 0.907 (95% CI 0.822–0.992).ConclusionsThe postoperative ISUP risk group could be predicted by Dmean and D*kurtosis from mpMRI, especially D*kurtosis. Obtaining the biexponential IVIM parameters is important for better risk stratification for PCa.

Download Full-text

55例血管免疫母细胞性T细胞淋巴瘤的临床特征和预后模型

Blood ◽

10.1182/blood-2020-141699 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 37-38

Author(s):

Xiaohong Tan ◽

Jie Sun ◽

Sha He ◽

Chao Rong ◽

Hong Cen

Keyword(s):

High Risk ◽

Prognostic Model ◽

Risk Group ◽

Prognostic Index ◽

Risk Groups ◽

High Risk Group ◽

Low Risk ◽

Intermediate Risk ◽

Ecog Ps ◽

Medical University

Angioimmunoblastic T-cell lymphoma (AITL) is a distinct subtype of peripheral T-cell lymphoma with unique clinical and pathological features. This study aim to analyze the characteristics of AITL and to design a prognostic model specifically for AITL, providing risk stratification in affected patients. We retrospectively analyzed 55 newly diagnosed AITL patients at the Affiliated Tumor Hospital of Guangxi Medical University from January 2007 to June 2016 and was permitted by the Ethics Committee of the Affiliated Tumor Hospital of Guangxi Medical University. Among these patients, the median age at diagnosis was 61 (27-85) and 54.55% (30/55) of the patients were older than 60 years. 43 patients were male, accounting for 78.18% of the whole. Among these, 92.73% (51/55) of the diagnoses were estimated at advanced stage. A total of 20 (36.36%) patients were scored >1 by the ECOG performance status. Systemic B symptoms were described in 16 (29.09%) patients. In nearly half of the patients (27/55; 49.09%) had extranodal involved sites. The most common extranodal site involved was BM (11/55; 20.00%). 38.18% (21/55) and 27.27% (15/55) patients had fever with body temperature ≥37.4℃ and pneumonia, respectively. 40% (22/55) patients had cavity effusion or edema. Laboratory investigations showed the presence of anemia (hemoglobin <120 g/L) in 60% (33/55), thrombocytopenia (platelet counts <150×109/L) in 29.09% (16/55), and elevated serum LDH level in 85.45% (47/55) of patients. Serum C-reactive protein and β2-microglobulin levels were found to be elevated in 60.98% (25/41) and 75.00% (36/48)of the patients, respectively. All patients had complete information for stratification into 4 risk subgroups by IPI score, in which scores of 0-1 point were low risk (9/55;16.36%), two points were low-intermediate risk (17/55; 30.92%), three points were high-intermediate risk (20/55; 36.36%), and four to five points were high risk (9/55; 16.36%). 55 patients were stratified by PIT score with 7.27% (4/55) of patients classified as low risk, 32.73% (18/55) as low-intermediate risk, 34.55% (19/55) as high-intermediate risk, and 25.45% (14/55) as high risk depending on the numbers of adverse prognostic factors.The estimated two-year and five-year overall survival (OS) rate for all patients were 50.50% and 21.70%. Univariate analysis suggested that ECOG PS (p= 0.000), Systemic B symptoms (p= 0.006), fever with body temperature ≥ 37.4℃ (p= 0.000), pneumonia (p= 0.001), cavity effusion or edema (p= 0.000), anemia (p= 0.013), and serum LDH (p= 0.007) might be prognostic factors (p< 0.05) for OS. Multivariate analysis found prognostic factors for OS were ECOG PS (p= 0.026), pneumonia (p= 0.045), and cavity effusion or edema(p= 0.003). We categorized three risk groups: low-risk group, no adverse factor; intermediate-risk group, one factor; and high-risk group, two or three factors. Five-year OS was 41.8% for low-risk group, 15.2% for intermediate-risk group, and 0.0% for high-risk group (p< 0.000). Patients with AITL had a poor outcome. This novel prognostic model balanced the distribution of patients into different risk groups with better predictive discrimination as compared to the International Prognostic Index and Prognostic Index for PTCL. Disclosures No relevant conflicts of interest to declare.

Download Full-text

A Stratification System of Ferroptosis and Iron-Metabolism Related Lncrnas Guides the Prediction of The Survival of Patients with Esophageal Squamous Cell Carcinoma

10.21203/rs.3.rs-927198/v1 ◽

2021 ◽

Author(s):

Fangchao Zhao ◽

Ren Niu ◽

Yishuai Li ◽

Zefang Dong ◽

Xuebo Qin ◽

...

Keyword(s):

Regression Analysis ◽

Risk Stratification ◽

Iron Metabolism ◽

Cox Regression ◽

Risk Group ◽

High Risk Group ◽

Cox Regression Analysis ◽

Stratification System ◽

Risk Stratification System

Abstract Background: As the major type of esophageal cancer (ESCA), esophageal squamous cell carcinoma (ESCC) is also related to the highest malignant level and low survival rates across the world. Increasing people recognize long non-coding RNAs (lncRNAs) as significant mediators in regulating ferroptosis and iron-metabolism. Determining the prognostic value of ferroptosis and iron-metabolism related lncRNAs (FIRLs) in ESCC is thus critical. Methods: Pearson’s correlation analysis was carried out between ferroptosis and iron-metabolism-related genes (FIRGs) and all lncRNAs to derive the FIRLs. Based on weighted gene co-expression network exploration (WCGNA), least absolute shrinkage and selection operator (LASSO) regression and Cox regression analysis, a risk stratification system was established. According to Kaplan-Meier analysis, receiver operating characteristic (ROC) curve analysis, and univariate and multivariate Cox regression analyses, the predictive ability and clinical relevance of the risk stratification system were evaluated. The validity of the established prognostic signature was further examined in TCGA (training set) and GEO (validation set) cohorts. A nomogram with enhanced precision for forecasting OS was set up on basis of the independent prognostic elements. Gene Ontology (GO) term enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were applied for the identification of pathways in which FIRLs significantly enriched. we used cell culture, transfection, CCK-8, and qRT-PCR as in vitro assays. Results: An 3-FIRLs risk stratification system was developed by multivariate Cox regression analysis to divide patients into two risk groups. Patients in the high-risk group had worse prognosis than patients in the low-risk group. Multivariate Cox regression analysis showed the risk stratification system was an independent prognostic indicator. Receiver operating characteristic curve (ROC) analysis proved the predictive accuracy of the signature. The area under time-dependent ROC curve (AUC) reached 0.853 at 1 year, 0.802 at 2 years, 0.740 at 5 years in the training cohort and 0.712 at 1 year, 0.822 at 2 years, 0.883 at 5 years in the validation cohort. Functional enrichment analysis predicted potential associations of 49 possible upstream regulated FIRGs with ferroptosis and iron-metabolism processes and oncological signatures. Analysis of the immune cell infiltration landscape showed that ESCC in the high-risk group tended be immunologically “cold”. In vitro experiments suggested that LINC01068 promoted ESCC cell proliferation. Conclusion: The risk stratification system based on FIRLs could serve as a reliable tool for forecasting the survival of patients with ESCC.

Download Full-text

Prognostic Factors in Follicular Lymphoma Patients in Japan: Application of Follicular Lymphoma International Prognostic Index.

Blood ◽

10.1182/blood.v106.11.4702.4702 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4702-4702

Author(s):

Chizuko Hashimoto ◽

Heiwa Kanamori ◽

Naoto Tomita ◽

Shin Fujisawa ◽

Etsuko Yamazaki ◽

...

Keyword(s):

High Risk ◽

Follicular Lymphoma ◽

Response Rate ◽

Risk Group ◽

International Prognostic Index ◽

Prognostic Index ◽

High Risk Group ◽

Prognostic Models ◽

Appropriate Treatment ◽

New Treatment

Abstract Background: By the new treatment approaches, such as anti-CD20 monoclonal antibody, purine analogues, high-dose therapy with SCT, the outcome of treatment for follicular lymphoma (FL) has been improved, but there is no consensus on any of these approaches except cases with early stage. Therefore, a reliable prognostic index would be needed in order to select the most appropriate treatment. Follicular Lymphoma International Prognostic Index (FLIPI) has recently been reported. We assessed characteristics at diagnosis and applied two prognostic models, the FLIPI and the IPI, to newly diagnosed Japanese patients (pts) with FL in this study. Methods: Response rate, overall survival (OS), and progression free survival (PFS) were calculated by the FLIPI and the IPI. For two prognostic models, 5 factors were used, The IPI (age>60, EN≥2, LDH>N, PS≥2, CS≥3), and the FLIPI (age>60, Hb<12.0g/dl, LDH>N, CS≥3, nodal sites>4), respectively. Results: Between 1988 and 2001, 107 pts of newly diagnosed FL (grade I-III) were analyzed. Patients characteristics were male/female 49/58, median age 54yr. (range 21–87yr.), and histological grade I, II/III 103/4. Initial therapy was CHOP-like regimen for 56 patients, ACOMP-B (the third generation regimen) for 44 patients, and another for 7 patients. The median follow-up of our series was 84 months (range 40–206 mo.). CR, PR was 60.7%, 31.8%, and response rate was 92.5%. Median OS at 15 years was 64.4%, and median PFS at 15 years was 28.5%. Patient distribution by the IPI and the FLIPI were the followings; the IPI (L/LI/HI/H 49/41/15/2), the FLIPI (L/I/H 41/29/37). There were few patients equivalent to high risk group in IPI, and it was the patient distribution which was more equal in FLIPI in comparison with IPI. OS by the IPI and the FLIPI risk group at 10 year were L: 85%, LI: 54%, HI: 44%, H: 50% (p=0.0088), and L: 87%, I: 66%, H: 47% (p<0.0001). PFS by the IPI and the FLIPI risk group at 10 year were L: 36%, LI: 23%, HI: 27%, H: 0% (p=0.0679), and L: 43%, I: 25%, H: 16% (p=0.0003). Correlation with a survival was recognized in FLIPI on OS, PFS more by significantly. In high-risk group of the FLIPI, PFS was significantly longer in pts treated with ACOMP-B, compared with pts treated with CHOP-like regimen (p=0.0015), and it tended to be better in OS, not so significant. Conclusions: The FLIPI is a promising consequence prediction model in follicular lymphoma in Japan. Standard treatment of FL is one of the most controversial issues. Outcome of CHOP were poor in high-risk group of the FLIPI, so to improve survival new treatment strategy is needed. The therapeutic strategy on the basis of different risks by reliable prognostic index, such as the FLIPI is necessary in future, in order to select the most appropriate treatment. As for grade 3, there was a little number of patients in our series, but further examination is necessary for adaptation of the FLIPI about this group.

Download Full-text

Nongastric Marginal Zone B-Cell Lymphoma: A Prognostic Model from a Retrospective Multicenter Study.

Blood ◽

10.1182/blood.v110.11.1361.1361 ◽

2007 ◽

Vol 110 (11) ◽

pp. 1361-1361

Author(s):

Sung Yong Oh ◽

Hyuk-Chan Kwon ◽

Won Seog Kim ◽

Yeon Hee Park ◽

Kihyun Kim ◽

...

Keyword(s):

B Cell ◽

Marginal Zone ◽

Cell Lymphoma ◽

Risk Group ◽

International Prognostic Index ◽

Prognostic Index ◽

Progression Free Survival ◽

B Cell Lymphoma ◽

High Risk Group ◽

Intermediate Risk

Abstract Purpose: The International Prognostic Index (IPI) and Follicular Lymphoma Prognostic Index (FLIPI) are used as prognostic indices for NHL and indolent lymphoma. However, marginal zone B-cell Lymphoma (MZL) evidences a distinctive clinical presentation and a natural course; thus, in this study, we attempted to devise an adequate prognostic index for MZL. Patients and method: From 1990 to 2005, 205 patients diagnosed with MZL were retrospectively reviewed. After analysis of the prognostic factors, progression free survival (PFS) and overall survival (OS), we constructed a prognostic index of MZL (MZLPI) via the summation of each factor. We then compared PFS and OS with IPI, FLIPI, and MZLPI. Results: According to our multivariate analysis of PFS and OS of MZL, nodal MZL, ECOG performance ≥ 2 and advanced stage were composed of MZLPI. MZLPI was grouped as follows: score 0 as a low risk group, score 1 as an intermediate risk group, and score ≥2 as a high risk group. The PFS curve, according to MZLPI results, evidenced a more discriminated pattern than IPI and FLIPI, and this was especially true in the intermediate risk group. In OS, MZLPI (P=0.0007) evidenced a more discriminated pattern than IPI (P=NS) or FLIPI (P=0.0044). Conclusion: MZLPI, which is constructed of relatively simple factors, may represent a useful prognostic index for the prediction of PFS and OS in MZL, and may also be used as a substitute for IPI or FLIPI.

Download Full-text

The operative risk stratification models in cardiac surgery: EuroSCORE II model - risk groups categorization

Vojnosanitetski pregled ◽

10.2298/vsp180516124n ◽

2020 ◽

Vol 77 (6) ◽

pp. 607-613

Author(s):

Dusko Nezic ◽

Miroslav Milicic ◽

Ivana Petrovic ◽

Dragana Kosevic ◽

Slobodan Micovic

Keyword(s):

Cardiac Surgery ◽

High Risk ◽

Risk Stratification ◽

Risk Group ◽

Risk Groups ◽

High Risk Group ◽

Operative Risk ◽

Discriminative Power ◽

Mortality Ratio ◽

Good Calibration

Background/Aim. The treshold that defines a low, moderate or high-risk patients is not uniformly determined for the European System for Cardiac Operative Risk Evaluation (EuroSCORE II) by literature at present. The aim of this study was to suggest risk groups categorization within EuroSCORE II risk statification model. Methods. A 7,641 consecutive patients were scored preoperatively using EuroSCORE II. The end point for the study was in-hospital mortality accross the risk group categories. Patients with EuroSCORE II values of ? 2.50, > 2.50?6.50%, and > 6.50% were defined to be at low, moderate, and high perioperative risk, respectively. Discriminative power of the model was tested by calculating the area under the receiver operating characteristic curve (AUC). The calibration of the model was assessed by Hosmer-Lemeshow statistics, and with observed/expected (O/E) mortality ratio. Results. Inhospital mortality observed in our sample was 3.85% (295 out of 7,641 patients). The EuroSCORE II discriminative power was acceptable (AUCs > 0.70) for the low and high risk groups, while it failed to confirm good discrimination in the moderate risk group. Hosmer-Lemeshow statistics confirmed good calibration across risk group categories. The O/E mortality ratio failed to confirm good calibration in the low and high risk group (slight, but significant underprediction ratio of 1.24; 95% confidence interval 1.05?1.43), but confirmed good calibration in all three subcategories of the high risk group. Conclusion. The results of this study showed an acceptable overall performance of the Euro- SCORE II in terms of discrimination and accuracy of model predictions for perioperative mortality across risk group categories. Validation of EuroSCORE II performances across risk group categories needs to be further studied for a continuous improvement of patients' risk stratification before planned cardiac surgery.

Download Full-text