Retrospective Analytical Study On Clinical Features And Prognostic Models For Patients With Head And Neck Diffuse Large B-cell Lymphoma

Purpose:Head and neck diffuse large B-cell lymphoma(HN-DLBCL)is one of most common aggressive non-Hodgkin’s lymphoma involving this anatomical site.With the clinical application of rituximab-containing immunochemotherapy and local radiotherapy as well as cellular immunotherapy,treatment outcomes of HN-DLBCL patients have dramatically improved not only rates of response,but also progression-free survival.However,a number of patients become relapsed/refractory cases.Previous clinical studies showed that risk-adapted treatment strategies could allow prompt and tailored intervention for high-risk patients thereby significantly reducing probabilities of being relapsed or refractory cases.The present study aimed to systematically analyze clinical features and their prognostic values in HN-DLBCL patients,and compare stratification efficacies of different prognostic models.Methods: A total of 134 patients with HN-DLBCL in our hospital from January 2010 to December 2018 were retrospectively identified and systemically analyzed.Survival curves were estimated using Kaplan-Meier survival methodology.The prognostic influence of clinical factors on survival were studied by univariate Log-rank test and multivariate Cox proportional hazards regression models.Three prognostic models including International Prognostic Index(IPI),National Comprehensive Cancer Network-IPI(NCCN-IPI)and Spanish Lymphoma/Autologous Bone Marrow Transplant Working Group-IPI(GELTAMO-IPI)were applied for risk stratification to compare 3-year survival rates among patients in different risk group.Results: Univariate analysis identified prognostic factors for HN-DLBCL patients including Ann Arbor stage,non-Germinal Center B-cell(non-GCB)subtype,serum lactate dehydrogenase(LDH)and β2 microglobulin value,while multivariate Cox regression analysis revealed that serum LDH level was the independent prognostic indicator.The predicted 3-year overall survival(OS)of IPI,NCCN-IPI and GELTAMO-IPI stratified high-risk HN-DLBCL patients were 44.7%,36.8% and 32.8%,while their 3-year progression-free survival(PFS)were 44.3%,20.7% and16.3%,respectively.NCCN-IPI and GELTAMO-IPI demonstrated enhanced discrimination than IPI for high-risk HN-DLBCL cases(IPI vs NCCN-IPI vs GELTAMO-IPI: 3-year PFS : 44.3% vs20.7% vs 16.3%).Conclusions: In immunochemotherapy era,LDH level was independent poor prognostic factor in HN-DLBCL patients.Modified prognostic models including NCCN-IPI and GELTAMO-IPI might be more powerful than IPI in predicting high-risk patients.