A Prognostic Analysis Of Primary Gastrointestinal Diffuse Large B-Cell Lymphoma Based On Systemic Inflammation Response Index

Background:Systemic inflammation response index(SIRI)is a novel inflammatory hallmark that is suggested as an adverse prognosticator in various malignancies.Nonetheless,the association between SIRI and primary gastrointestinal diffuse large B cell lymphoma(PGI-DLBCL)remains undetermined.Our study intended to assess the prognostic value of SIRI in PGI-DLBCL patients treated with CHOP-based therapies and establish a highly discriminating risk prediction model compared with the National Comprehensive Cancer Network-International Prognostic Index(NCCN-IPI)score.Methods:Present retrospective analysis included 153 PGI-DLBCL patients(57 patients with gastric DLBCL and 45 patients with intestinal DLBCL)newly diagnosed between January 2011 and February 2022 and divided them into a training set(n=102)and a validation set(n=51),The SIRI was calculated by utilizing the peripheral blood neutrophil(N),monocyte(M),and lymphocyte(L)counts collected in the last ≤3 days before the initiation of the immunochemotherapy:SIRI=N× M/L.The study population could be divided into two groups with distinct overall survival(OS)outcomes using the pretreatment SIRI cutoff determined by the receiver operating characteristic(ROC)curve analysis.The prognostic factors associated with OS,the primary endpoint,were screened by multivariate Cox regression analyses and log-rank test as well as progression-free survival(PFS),the secondary endpoint.Results:A total of 153 patients were included in our study,including 86 patients with gastric DLBCL and 67 patients with intestinal DLBCL,with a median age of 56 years(range 18-84 years).There were 86(56.2%)males and 67(43.8%)females.The median follow-up time was 32.0 months(95%CI:24.8-39.2),ranging from 2 to 120 months.A total of 45 patients(29.3%)presented B symptoms at the initial assessment,110(71.9%)patients had stage Ⅲ or Ⅳ disease,and 37(24.2%)patients exhibited more than one extranodal involvement.Cox regression analysis found three negative prognostic factors on OS:SIRI≥1.34(HR:14.147,95%CI:1.368-146.292;P=0.026),B symptom(HR:18.789,95%CI:4.363-80.911;P=0.000),LDH>ULN(HR:6.754,95%CI:1.607-28.397;P=0.009).Accordingly,SIRI≥1.34(HR:2.811,95%CI:1.002-6.072;P=0.050),B symptom(HR:2.881,95%CI:1.321-6.280;P=0.008)and LDH>ULN(HR:2.452,95%CI:1.028-5.850;P=0.043)emerged to be the indicators in relation to considerably inferior PFS times.Consequences of the multivariate analyses suggested that the prognostic significance of the SIRI on OS and PFS outcomes was independent of the other confounders.Patients with SIRI≥1.34 were allocated 2 points as a risk factor which was calculated according to the β coefficients compared with the effect of LDH level(>ULN)in the multivariate analysis of OS.This established an integrated scoring model with a maximum of 10 points when we combined NCCN-IPI with SIRI.Consequently,the prognostic and discriminatory capability of the NCCN-IPI plus SIRI was superior to NCCN-IPI alone(AUC:0.916 vs 0.835)and(C-index:0.912 vs 0.836)based on OS in this patient population.Moreover,NCCN-IPI plus SIRI also showed good discriminative power for efficacy assessment.Likewise,this new model was able to identify patients at risk of developing severe gastrointestinal complications following chemotherapy(AUC:0.802).Conclusion:The results of this retrospective cohort analysis suggested that a pretreatment SIRI was a potent and independent prognostic indicator that may be a potential candidate for identifying patients with poor prognosis in the future clinical practice of PGI-DLBCL.