Abstract
BackgroundThe systemic inflammatory response has been postulated as having prognostic significance in a wide range of different cancer types. We aimed to assess the prognostic role of inflammatory markers on survival in HIV-infected patients with Non-Hodgkin Lymphoma (NHL), and to compute a prognostic score based on inflammatory biomarkers.MethodsWe evaluated data on HIV patients with NLH diagnosis between 1998 and 2012 in a HIV Italian Cohort. Using Cox proportional regression model, we assessed the prognostic role of Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR), Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), Prognostic Index (PI), and Prognostic Nutritional Index (PNI). We also computed a risk score equation, assigning patients to a derivation and a validation sample. The area under the curve (AUC) was use to evaluate the predictive ability of this score.Results215 non-Hodgkin lymphoma cases (80.0% males) with a mean age of 43.2 years were included. Deaths were observed in 98 (45.6%) patients during a median follow up of 5 years. GPS, mGPS, PI and PNI were independently associated with risk of death. We also computed a mortality risk score which included PNI and occurrence of an AIDS event within six months from NHL diagnosis. The AUCs were 0.69 (95% CI 0.58 to 0.81) and 0.69 (95% CI 0.57 to 0.81) at 3 and 5 years of the follow-up, respectively.ConclusionsGPS, mGPS, PI and PNI are independent prognostic factors for survival of HIV patients with NHL.
Highlights
Non-Hodgkin Lymphoma (NHL) is one of the most common cancer and cause of death among HIV-infected patients [1,2,3]
Overall survival is poor and more than half subjects die within five years from NHL diagnosis, it has improved after the introduction of the combined Antiretroviral *In subjects with positive HIV-RNA (Therapy) [2,3,4,5,6,7,8,9]
Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), Prognostic Index (PI) and Prognostic Nutritional Index (PNI) were independently associated with risk of death using both univariate and multivariate Cox models
Summary
Non-Hodgkin Lymphoma (NHL) is one of the most common cancer and cause of death among HIV-infected patients [1,2,3]. Raffetti et al Journal of Translational Medicine (2015) 13:89 showed that some blood parameters associated with systemic inflammation, i.e. C-Reactive Protein (CRP), white cell, neutrophil and platelet count, and hypoalbuminemia are predictors of survival in patients with primary solid cancers [12]. Various combinations of these factors have been used to derive inflammation-based scores to predict survival of subjects with solid cancers [13,14,15,16], such as Glasgow Prognostic Score (GPS), Neutrophil/Lymphocyte Ratio (NLR) and Platelet/Lymphocyte Ratio (PLR). We aimed to assess the prognostic role of inflammatory markers on survival in HIVinfected patients with Non-Hodgkin Lymphoma (NHL), and to compute a prognostic score based on inflammatory biomarkers
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