Prognostic value of international prognostic index, revised international prognostic index, enhanced international prognostic index and Grupo Español de Linfomas/trasplante autólogo de médula ósea-international prognostic index for diffuse large B-cell lymphoma

Abstract

Objective: To compare the prognostic values of international prognostic index (IPI), revised international prognostic index (R-IPI), enhanced international prognostic index (NCCN-IPI) and Grupo Español de Linfomas/trasplante autólogo de médula ósea-international prognostic index (GELTAMO-IPI) for diffuse large B-cell lymphoma (DLBCL). Methods: The clinical data of 238 DLBCL patients who were initially treated in Shanxi Cancer Hospital from September 2011 to March 2016 were collected retrospectively, the risk stratification and prognostic evaluation were conducted according to the IPI, R-IPI, NCCN-IPI and GELTAMO-IPI. Survival analysis was performed by the Kaplan-Meier method, COX regression analysis was used to compare the risks of death and progress in each group. Harrell's C statistics was used to compare the prediction accuracy of each hazard stratification model. Results: The 3-years progression-free survival rates of low risk, middle-low risk, middle-high risk and high risk group stratified according to IPI were 90.9%, 67.5%, 54.0% and 52.4%, respectively. The 3-years overall survival rates of each group were 93.9%, 72.5%, 58.0% and 53.7%, respectively. The 3-years progression-free survival rates of patients with very good prognosis, good prognosis and poor prognosis were 90.9%, 79.8% and 53.0%, respectively, the 3-years overall survival rates were 95.5%, 83.3% and 55.3%, respectively. The 3-years of progression-free survival of low risk group, middle-low risk group, middle-high risk group and high risk group stratified according to NCCN-IPI were 91.7%, 76.5%, 66.7% and 41.1%, respectively. The 3-years overall survival rates of each group were 95.8%, 79.4%, 70.0% and 42.9%, respectively. The 3-years progression-free survival rates of low risk, middle-low risk, middle-high risk and high risk group stratified according to GELTAMO-IPI were 91.3%, 76.3%, 67.4% and 32.7%, respectively. The 3-years overall survival rates of each group were 95.7%, 80.7%, 67.4% and 34.5%, respectively. Cox regression analysis showed that the risks of progression and death were significantly different between the middle-low risk group and low risk group of IPI (HR=4.144 and 5.085). The risks of progression and death were significantly different between the poor prognosis group and good prognosis group of R-IPI (HR=2.752 and 3.171), but both of which were significantly lower than the IPI groups. The risk stratification showed that the risks of progression and death were significantly different between the high risk group and middle-high risk group of NCCN-IPI and GELTAMO-IPI. However, the screening ability of high risk patients in GELTAMO-IPI group was better than that of NCCN-IPI group (NCCN-IPI HR=2.290 and 2.309, GELTAMO-IPI HR=3.084 and 2.966). Harrell's C-index analysis showed that the C-indexes of 3-years progression-free survival prediction in IPI, R-IPI, NCCN-IPI and GELTAM0-IPI were 0.672, 0.641, 0.664 and 0.700, respectively (P<0.001). The C-indexes of 3-years overall survival prediction were 0.687, 0.653, 0.671 and 0.721, respectively (P<0.001). The C-index of GETAMO-IPI was highest, superior to other prediction models. Conclusions: The screening abilities of GELTAMO-IPI and NCCN-IPI for high-risk DLBCL patients are better than those of IPI and R-IPI. The prediction accuracy of GELTAMO-IPI is significantly better than other prognostic stratified models.