Abstract
Diffuse large B-cell lymphoma (DLBCL) is a biologically and clinically heterogenous disease. Identifying more precise and individual survival prognostic models are still needed. This study aimed to develop a predictive nomogram and a web-based survival rate calculator that can dynamically predict the long-term cancer-specific survival (CSS) of DLBCL patients. A total of 3,573 eligible patients with DLBCL from 2004 to 2015 were extracted from the Surveillance, Epidemiology and End Results (SEER) database. The entire group was randomly divided into the training (n = 2,504) and validation (n = 1,069) cohorts. We identified six independent predictors for survival including age, sex, marital status, Ann Arbor stage, B symptom, and chemotherapy, which were used to construct the nomogram and the web-based survival rate calculator. The C-index of the nomogram was 0.709 (95% CI, 0.692–0.726) in the training cohort and 0.700 (95% CI, 0.671–0.729) in the validation cohort. The AUC values of the nomogram for predicting the 1-, 5-, and 10- year CSS rates ranged from 0.704 to 0.765 in both cohorts. All calibration curves revealed optimal consistency between predicted and actual survival. A risk stratification model generated based on the nomogram showed a favorable level of predictive accuracy compared with the IPI, R-IPI, and Ann Arbor stage in both cohorts according to the AUC values (training cohort: 0.715 vs 0.676, 0.652, and 0.648; validation cohort: 0.695 vs 0.692, 0.657, and 0.624) and K-M survival curves. In conclusion, we have established and validated a novel nomogram risk stratification model and a web-based survival rate calculator that can dynamically predict the long-term CSS in DLBCL, which revealed more discriminative and predictive accuracy than the IPI, R-IPI, and Ann Arbor stage in the rituximab era.
Highlights
Diffuse large B-cell lymphoma (DLBCL) is the most common type of aggressive lymphoma, accounting for 30–40% of all newly diagnosed non-Hodgkin lymphomas (NHL) [1]
The nomogram exhibited that age made the largest contribution to survival outcome, followed by Ann Arbor stage, chemotherapy, marital status, sex, and B symptom (Figure 3)
Ann Arbor stage was unsatisfactory for the stratification of patients with stage I and II, stage III and IV disease in both sets (Figures 8D, H). These results revealed that the established nomogram risk stratification model indicated greater discriminatory capacity and accuracy in cancer-specific survival (CSS) prediction of DLBCL compared with the International Prognostic Index (IPI), R-IPI, and Ann Arbor stage
Summary
Diffuse large B-cell lymphoma (DLBCL) is the most common type of aggressive lymphoma, accounting for 30–40% of all newly diagnosed non-Hodgkin lymphomas (NHL) [1] It is a heterogeneous group of lymphomas in terms of clinical presentation, tumor biology and prognosis [2]. The International Prognostic Index (IPI) [5] and its subsequent revisions [Revised‐IPI (R‐IPI)] [6] and National Comprehensive Cancer Network IPI (NCCN-IPI) [7] remain the most useful prognostications for DLBCL. These scoring systems were based on similar factors: patient age, Eastern Cooperative Oncology Group (ECOG) performance status (PS), Ann Arbor stage, serum lactate dehydrogenase (LDH), and extranodal involvement. NCCN‐IPI has been shown to provide better risk stratification than the IPI, it was still insufficiently accurate to be applied in clinical practice
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