Abstract
Background: Few studies have focused on risk stratification and adapted therapy for advanced-stage natural killer/T-cell lymphoma (NKTCL). Methods: This retrospective study evaluated 406 patients with advanced-stage NKTCL who were treated at 20 Chinese institutions. A model for predicting overall survival (OS) was developed using multivariate analysis of data from a South China cohort (n=198), and validation was performed using a North China cohort (n=208). The prognostic model was also used to evaluate the survival benefits of different chemotherapy regimens. Findings: The median age was 42 years and the male/female ratio was 2.5:1. All patients received chemotherapy, with the most common option being asparaginase (Asp)-containing regimens (n = 149; 36.7%). The expected 3-year OS rate was 37.3%. The prognostic model (advanced-stage NKTCL prognostic index, ASPRIN) was based on Eastern Cooperative Oncology Group performance status >1, elevated lactate dehydrogenase and solid organ involvement. The expected 3-year OS rates in the primary cohort were 54.8% for low-risk cases (no risk factors), 34.4% for intermediate-risk cases (1 risk factor), and 13.8% for high-risk cases (2–3 risk factors). Similar results were observed in the validation cohort. After matching according to ASPRIN scores, Asp-containing chemotherapy provided an approximately 12% increase in the expected 3-year OS rate, relative to non-Asp-containing chemotherapy. However, the inclusion of additional cytotoxic agents did not enhance the survival benefit provided by Asp-containing chemotherapy. Interpretation: The ASPRIN model was effective for stratifying the prognosis of advanced-stage NKTCL, which may help improve our understanding of the existing chemotherapy regimens. More effective risk-adapted therapeutic strategies are also needed. Funding Statement: This study was supported by the Capital’s Funds for Health Improvement and Research (grant no. 2018- 1-2151). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study’s retrospective protocol was approved by the participating centers’ institutional review boards and complied with the Declaration of Helsinki. The requirement for informed consent was waived based on the use of a deidentified data set.
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