Abstract
BackgroundC-reactive protein (CRP) is a biomarker of the inflammatory response, and it shows significant prognostic value for several types of solid tumors. The prognostic significance of CRP for lymphoma has not been fully examined. We evaluated the prognostic role of baseline serum CRP levels in patients with extranodal natural killer (NK)/T-cell lymphoma (ENKTL).MethodsWe retrospectively analyzed 185 patients with newly diagnosed ENKTL. The prognostic value of the serum CRP level was evaluated for the low-CRP group (CRP≤10 mg/L) versus the high-CRP group (CRP>10 mg/L). The prognostic value of the International Prognostic Index (IPI) and the Korean Prognostic Index (KPI) were evaluated and compared with the newly developed prognostic model.ResultsPatients in the high-CRP group tended to display increased adverse clinical characteristics, lower rates of complete remission (P<0.001), inferior progression-free survival (PFS, P = 0.001), and inferior overall survival (OS, P<0.001). Multivariate analysis demonstrated that elevated serum CRP levels, age >60 years, hypoalbuminemia, and elevated lactate dehydrogenase levels were independent adverse predictors of OS. Based on these four independent predictors, we constructed a new prognostic model that identified 4 groups with varying OS: group 1, no adverse factors; group 2, 1 factor; group 3, 2 factors; and group 4, 3 or 4 factors (P<0.001). The novel prognostic model was found to be superior to both the IPI in discriminating patients with different outcomes in the IPI low-risk group and the KPI in distinguishing between the low- and intermediate-low-risk groups, the intermediate-low- and high-intermediate-risk groups, and the high-intermediate- and high-risk groups.ConclusionsOur results suggest that pretreatment serum CRP levels represent an independent predictor of clinical outcome for patients with ENKTL. The prognostic value of the new prognostic model is superior to both IPI and KPI.
Highlights
Extranodal natural killer (NK)/T-cell lymphoma (ENKTL), nasal type, is a distinct and heterogeneous histopathologic subtype of non-Hodgkin lymphoma (NHL) characterized by vascular damage and destruction, prominent necrosis, and association with Epstein-Barr virus (EBV) [1]
A new prognostic model, the Korean Prognostic Index (KPI), which is specific for extranodal natural killer (NK)/T-cell lymphoma (ENKTL), nasal type, has been proposed, and its prognostic value has been verified by several studies [3,4,5]
ENKTL was divided into two subtypes: upper aerodigestive tract NK/T-cell lymphoma (UNKTL) and extra-upper aerodigestive tract NK/T-cell lymphoma (EUNKTL) according to the definitions given in previous studies [3,4]
Summary
Extranodal natural killer (NK)/T-cell lymphoma (ENKTL), nasal type, is a distinct and heterogeneous histopathologic subtype of non-Hodgkin lymphoma (NHL) characterized by vascular damage and destruction, prominent necrosis, and association with Epstein-Barr virus (EBV) [1]. The poor prognosis and significant heterogeneity of ENKTL emphasize the need for more efficient prognostic factors or models to stratify patients with different survival outcomes. The prognostic value of the International Prognostic Index (IPI) has been well validated for many subtypes of NHL, its prognostic significance for ENKTL remains controversial [3,4,5,6,7]. A new prognostic model, the Korean Prognostic Index (KPI), which is specific for ENKTL, nasal type, has been proposed, and its prognostic value has been verified by several studies [3,4,5]. We evaluated the prognostic role of baseline serum CRP levels in patients with extranodal natural killer (NK)/T-cell lymphoma (ENKTL)
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