The purpose of this study was to develop a newly accepted prognostic nomogram to estimate overall survival (OS) in patients with diffuse large B-cell lymphoma (DLBCL) and assess its incremental value to the traditional International Prognostic Index (IPI) and NCCN-IPI for individual OS estimation.
The clinical data from 1,118 patients with DLBCL treated at Cancer Hospital Chinese Academy of Medical Sciences between 2006 and 2012 were reviewed. A nomogram was developed that predicted OS based on the Cox proportional hazards model. To contrast the utility of the nomogram against the widely used IPI and NCCN-IPI, we used the concordance index (C-index) and a calibration curve to determine its predictive and discriminatory capacity.
The 5-year OS rate was 64.1% for the entire group. The entire group were divided into the primary (n = 783) and validation (n = 335) cohorts. The nomogram included eight important variables based on a multivariate analysis of the primary cohort: Ann Arbor stage; age; ECOG PS; LDH; β2-MG; CD5; Bcl-6 and Ki-67 index. The calibration curve showed that the nomogram was able to predict 5-year OS accurately. The C-index of the nomogram for OS prediction was 0.77 in the primary cohort and 0.76 in the validation, which was superior to the predictive power (range, 0.71-0.74) of the IPI and NCCN-IPI in the primary and validation cohorts. To detect the accuracy of the nomogram for rituximab plus CHOP (R-CHOP) like regimen, we took subgroup analysis. The C-index of the nomogram for OS prediction was 0.78 in the R-CHOP like regimen subgroup, and 0.76 in the CHOP like regimen subgroup.Table:
1005PD Multivariate analysis of 783 patients in the primary cohort
|Covariate||level||HR||95% CI||P-value||nomogram score|
|ECOG PS score||≥2||1.84||1.38-2.44|
The proposed nomogram provides an individualized risk estimate of OS in patients with DLBCL, especially for the patient who received R-CHOP like regimen.
Clinical trial identification
This project was approved by the Ethics Committee of Cancer Hospital, Chinese Academy of Medical Sciences.
Legal entity responsible for the study
National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
All authors have declared no conflicts of interest.