Abstract
25-hydroxy vitamin D [25-(OH)D] is widely used to determine vitamin D status in clinic. The aim of our study was to evaluate the prognostic value of 25-(OH)D in extranodal NK/T cell lymphoma (ENKTL). Ninety-three (93) ENKTL patients with available serum 25-(OH)D values were enrolled in our study. Vitamin D deficiency is defined as a 25-(OH)D below 50 nmol/L (20 ng/ml). Univariate and multivariate regression analyses were performed to determine independent risk factors for progression-free survival (PFS) and overall survival (OS). Receiver operator characteristic (ROC) curves were plotted, and corresponding areas under the curves (AUC) were calculated to estimate the accuracy of PINK-E (prognostic index of natural killer lymphoma added with Epstein-Barr virus-DNA status) and 25-(OH)D deficiency in ENKTL risk-stratification. Our results suggested that the vitamin D deficiency was an independent inferior prognostic factor for both PFS [hazard ratio (HR), 2.869; 95% confidence interval (CI), 1.540 to 5.346; P = 0.003] and OS (HR, 3.204; 95% CI, 1.559 to 6.583; P = 0.006) in patients with ENKTL. Additionally, we demonstrated that adding 25-(OH)D deficiency to PINK-E score system indeed has a superior prognostic significance than PINK-E alone for PFS [AUC: 0.796 (95% CI: 0.699 to 0.872) vs. 0.759 (95% CI: 0.659 to 0.841), P = 0.020] and OS [AUC: 0.755 (95% CI: 0.655 to 0.838) vs. 0.721 (95% CI: 0.618 to 0.809), P = 0.040]. In conclusion, our study proved that 25-(OH)D deficiency was associated with inferior survival outcome of ENKTL patients.
Highlights
Extranodal natural killer/T-cell lymphoma (ENKTL) is a well-characterized subtype of mature T/NK-cell lymphoma
Receiver operator characteristic (ROC) curves were plotted to estimate the accuracy of prognostic index of natural killer lymphoma (PINK)-E and 25-(OH)D deficiency in ENKTL risk-stratification
Our results suggested that vitamin D deficiency was an independent inferior prognostic factor for both progression-free survival (PFS) [hazard ratio (HR), 2.869; 95% confidence interval (CI), 1.540 to 5.346; P = 0.003] and overall survival (OS) (HR, 3.204; 95%CI, 1.559 to 6.583; P = 0.006) in ENKTL patients with age ≤ 60, ECOG Eastern Cooperative Oncology Group performance status (PS) ≤ 1, stage III‒IV and PINK-E score ≥ 3
Summary
Extranodal natural killer/T-cell lymphoma (ENKTL) is a well-characterized subtype of mature T/NK-cell lymphoma. The latest prognostic index of natural killer lymphoma (PINK) added with Epstein-Barr virus (EBV)-DNA status (PINKE) is a prognostic model based on non-anthracycline-based chemotherapy and it consists of five risk factors (age, stage, non-nasal type, distant lymph-node involvement, and EBV-DNA status) [2]. Studies have suggested that ultraviolet radiation has a protective effect on the development of lymphoma [6, 7], but 25-(OH)D has no significant effect on the risk of lymphoma [6,7,8,9,10]. Several studies have shown that 25-(OH)D is significant in the prognostic evaluation of lymphoma [11,12,13,14,15]. 25-(OH)D may be a good prognostic factor in lymphoma
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