The Clinical Prognostic Correlation Analysis And Model Establishment Of Lipid Metabolism Level In Patients Newly Diagnosed With Mature T And NK Cell Non-hodgkin Lymphomas

Background and objective:Mature T and NK cell lymphomas comprise a group of highly aggressive and heterogeneous lymphatic diseases derived from mature T or NK cells,which can be specifically divided into many different subtypes.Mature T and NK cell lymphomas most commonly affect adults and the elderly and its distribution shows significant regional disparities.The frequency of mature T and NK cell lymphoma accounts for 25%-30%in non-Hodgkin lymphoma(NHL)in Asia,which is significantly higher than that in the western countries(10%-15%).Compared with B cell lymphoma counterparts,mature T and NK cell lymphomas are distinguished for lower morbidity,poorer prognosis and higher mortality.In last decades,patients with T and NK cell lymphomas still face great difficulties in treatment and CHOP or CHOP-like standard chemotherapy regimens did not obviously benefit patients' survival.Hence,it is crucial for improving patients' clinical endings to precisely evaluate patients' prognosis and personalize the therapy options on the basis of accurate risk grades.Traditional IPI was observed some limitations in risk-stratification of T cell lymphoma.Although various prognostic markers and indices have been proposed in recent years,studies demonstrated that most prognostic indices were designed just for one certain subtype lymphoma and lacked for universality.Consequently,it is necessary and vital to seek for a universal prognostic scoring system which may be applied to the total mature T and NK cell lymphoma population efficiently.Dyslipidemia has been confirmed closely related to tumor progression.Several studies have indicated that abnormal serum cholesterol level was associated with inferior outcome of patients with solid tumors and several hematological malignancies.Nevertheless,the relevance of serum lipid profile abnormalities and clinical outcomes of patients with the mature T and NK cell lymphomas remains undiscovered.Therefore,the aim of our research is to examine the prognostic value of serum lipid composition to patients' clinical outcomes and develop a prognostic model including serum lipid level for newly diagnosed patients with mature T and NK cell lymphomas.Methods:We retrospectively analyzed a cohort consisting of 80 newly diagnosed patients with mature T and NK cell lymphomas from January 2011 to December 2018 at Shandong Provincial Hospital affiliated to Shandong University.The baseline data,such as gender,age,extranodal involved sites,bone marrow involvement.Eastern Cooperative Oncology Group(ECOG)performance status(PS)score,Ann-Arbor stage.IPI score and B symptoms were gathered.Laboratory examinations,including serum lactate dehydrogenase(LDH),?2-microglobulin(?2-MG),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)were also involved in.Later,we followed up patients'overall survival(OS)and progression-free survival(PFS),statistically analyzed the association and correlation of serum lipid profiles and other clinical characteristics and then explicated the prognostic value of serum lipid level to patients' survival outcomes.In addition,we found out all the prognostic factors by means of univariate and multivariate analyses and established a novel prognostic assessment model based on all independent prognostic factor's.Results:Total cholesterol(TC)and high-density lipoprotein cholesterol(HDL-C)presented a positive correlation but triglyceride(TG)exhibited an inverse correlation with clinical outcomes in patients with mature T and NK cell lymphomas.Patients with TC<3.57mmol/L or HDL-C<0.96mmol/L possessed notably shorter overall survival(OS,P=0.000 and 0.002,respectively)and progression-free survival(PFS,P=0.000 and 0.002.respectively).Patients with TG>1.41mmol/L revealed inferior OS(P=0.004)and PFS(P=0.004)than those with TG?1.41mmol/L.Multivariate Cox regression model revealed an independently protective significance of TC in patients' OS(HR.0.389;95%CI.0.206-0.733;P=0.003)and PFS(HR.0.446;95%CI.0.235-0.846;P=0.014).According to the results of multivariate Cox regression analysis,we further founded a novel prognostic model,EnBC index,based on three independent prognostic factors,extranodal sites,?2-MG level and TC level.The novel risk stratification model exhibited higher prognostic value than previous International Prognostic Index(IPI)(AUC difference,0.0977;95%CI,0.0066-0.189;P=0.0356)in treatment-naive mature T and NK cell lymphoma patients.Conclusion:In this study,we verified the prognostic significance of TC,TG and HDL-C in patients with the mature T and NK cell lymphomas and established an unprecedented prognostic model,EnBC index.Decreased TC and HDL-C,with elevated TG all implied higher invasiveness and poorer survival.As a novel prognostic stratification system,the EnBC index has a high predictive effect on the outcome of newly diagnosed mature T/NK cell lymphoma patients.Its simple accessibility and good repeatability favors EnBC index a bright clinical application prospect.