| Purpose:To validate the prognostic value of New Prognostic Score[8] for diffuse large B-cell lymphoma.Method: A total of 70 DLBCL patients who were initially diagnosed and treated in Fujian Medica University Union Hospital from May 2009 and March 2014 were included in the study. The following clinical information was analyzed: sex,age, lymphoma B symptoms,ECOG score, extranodal extension sites,Ann Arbor phase,blood lactate dehydrogenase(LDH), GCB/non-GCB pathological subtypes,the result of interim PET-CT, treatment strategies,progress-free survival time and overall survival time,and all patients were scored and performed survival analysis using the standard IPI and New Prognostic Score. The method of Kaplan-Meier was used for survival analysis,the Log-rank test was used for curve test,and the COX,s proportional hazards regression model was used for multiple prognostic factor analysis,the sensitivity,specificity, positive predictive value,negative predictive value,the coincidence rate of prognostic methods were calculated by Crosstab Aanlysis,all statistical significance were on the basis of 0.05.Result:The main clinical features were as follows:41cases(58.6%) were male,27 cases(38.6%) were older than 60 years of age,18 cases(25.7%) had Lymphoma B symptoms,14 cases(20.0%) were Eastern Cooperative Oncology Group Score(ECOG Score)?2,19 cases(27.1%) were extranodal extension sites ?2,34 cases(48.6%) had elevated lactate dehydrogenase level,44 cases(62.9%) were stage III/IVdisease,46 cases(65.7%) were non-GCB pathological subtype, 16 cases(22.9%) were positive interim PET-CT,54 cases(77.1%) were negative interim PET-CT.The 3-years PFS had statistical significance between DLBCL patietns with a negative interim PET-CT and positive those( 77.8% vs 31.3%,P<0.001),and the 3-years OS had statistical significance between them(87.0% vs 56.3%,p=0.004).According to the IPI risk categorization,22 cases(31.3%) were low risk,25 cases(35.7%) were low-intermediate risk,19 cases(27.1%) were high-intermediate risk,4 case(5.7%) were high risk,the 3-years PFS for four IPI risk groups were 77.3%,68.0%,36.8%,25.0%,and the 3-years OS for four ones were 90.9%,88.0%,68.4%,25.0%.According to the New Prognostic score risk categorization,23 cases(32.9%) were low risk,27cases(38.9%)were low-intermediate risk,16cases(22.9%) were high-intermediate risk,4 case(5.7%) were high risk,the 3-years PFS for four groups were 91.3%, 70.4%,31.3%,50.0%,and the 3-years OS for four ones were 100.0%,81.5%,56.2%,50.0%. Compared with the interim PET-CT,New Prognostic Score had higher sensitivity( 56.5% vs 47.8%,64.3% vs 50.0%) and negative predictive value(80.0% vs 78.7%,90.0% vs 87.0%) in predicting 3-years PFS and OS.Compared with the IPI,New Prognostic Score better discriminated low and low-intermediate risk groups(3-years OS:New Prognostic Score:100.0% vs 81.5%, P=0.028,IPI:90.9% vs 88.0%,P=0.715),low-intermediate and high-intermediate risk groups(3-years PFS:New Prognostic Score:91.3% vs 70.4%,P=0.009,IPI:77.3% vs 68.0%,P=0.797),and had higher sensitivity(56.5% vs 53.6%),specificity(85.1% vs 81.0%), positive predictive value(80.0% vs 72.3%),the coincidence rate(75.7% vs 70.0%) in predicting 3-years PFS,and specificity(80.4% vs 75.0%),positive predictive value(45.0% vs 39.1%),negative predictive value(90.0% vs 89.4%),the coincidence rate(77.1% vs 72.9%) in predicting 3-years OS.Conclusion:The result of interim PET-CT was a independent factor in prognosis,New Prognostic Score was a more comprehensive and individual prognostic model which was superior to the IPI,and provided a good reference for making a forwarding therapy strategies,and a certain clinical application prospect.It better discriminated low and low-intermediate risk groups,low- intermediate and high-intermediate risk groups,and had a good value in predicting 3-years PFS and OS,it need more studies to confirmed the discriminated value between high-intermediate and high risk groups,more prospective studies to explore and find whether we can adjust the treatment strategies according New Prognostic Score or not. |
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