| Objective: To compare the prognostic value of NCCN-IPI,IPI and R-IPI in patients with diffuse large B cell lymphoma(DLBCL)treated with R-CHOP.To analyze CD5 expression in DLBCL and to explore its relationship with the clinicopathological characteristics and prognosis.Methods: A total of 128 DLBCL patients who were initially diagnosed and treated in Fujian Provincal Hospital from January 2011 to January 2016 were included in the study.Of which 117 patients treated with R-CHOP were used to analyze the prognostic value of three kinds of prognostic index,and 67 cases by immunohistochemical examination of CD5 expression were used to analyze the relation between CD5 and the prognosis and clinical factors.Baseline characteristics were collected: gender,age,ECOG PS score,extranodal involvement lesions and number,B symptoms,Ann Arbor phase,pathological subtype,serum lactate,dehydrogenase(LDH),serum beta 2-microglobulin(?2-MG),the expression of CD5,treatment plan,progress-free survival time(PFS)and overall survival time(OS),and survival analysis was performed using the standard IPI,R-IPI and the new NCCN-IPI model.The relationship between CD5 expression and the clinicopathological characteristics was evaluated by Chi-squared test.Survival analysis adopted Kaplan-Meier analysis and Log-rank test,and the COX's propotional hazards regression model was used for multiple prognostic factor analysis.All statistical significant were on the basis of 0.05.Result: Among all the 117 patients treated with R-CHOP,the median age was 57(range:19-87)years,51.3% of them were male,66.7% were stage ?/?disease,29.9% were Eastern Cooperative Oncology Group Performance Status(ECOG PS)?2,50.4% had elevated LDH level(>245 U/L),and 54.7% had elevated?2-MG(>2.4mg/L).After a median follow-up of 31 months(range:1 ~ 72),the total efficiency of 59.8%,and 34.2% progressed or died(22.2%),the 3-year PFS and OS rates were(66.8 + 4.8)% and(77.4 + 4.3)%,respectively.Single factor analysis showed that PS score,LDH level,?2-MG level,IPI,R-IPI,NCCN-IPI had significant effect on PFS and OS(P<0.05).COX multivariate regression analysis showed that NCCN-IPI was a prognostic factor for PFS and OS.According to the old IPI risk categorization,33.3%,24.8%,22.2%,and 19.7% patients belonged to the four risk subgroups(low,low-intermediate,high-intermediate,and high).The corresponding percentages were 9.4%,48.7%,and 41.9 % in the R-IPI model,12.0%,46.2%,30.8%,and 11.1% in the NCCN-IPI model.The 3-year OS for the four NCCN-IPI risk groups were 92.9%,81.2%,82.7%,and 30.8%,respectively,whereas the rates were 92.3%,79.3%,78.6%,and 58.5% for the IPI risk groups,whereas the rates were 100.0%,84.1%,and 65.5%,for the R-IPI risk groups.Compared with the IPI and R-IPI,the NCCN-IPI better discriminated high-risk subgroups(NCCN-IPI vs.R-IPI vs.IPI : 3-year OS: 30.8% vs.65.5% vs.58.8%),but there was no significant difference in the low-risk group.Of the 67 patients with the available CD5 expression status,31 cases of them were CD5+DLBCL.In the patients older than 60 years old,the incidence of CD5+DLBCL(20/31)was significantly higher than that of CD5-DLBCL(13/36),P=0.028.There was no significant correlation between gender,PS score,risk stratification,LDH,Ann Arbor staging,pathological subtype,number of extranodal involvement and CD5 positive expression(P>0.05).Survival analysis showed that there was no significant difference of OS and PFS between CD5+DLBCL with CD5-DLBCL,but for the low risk patients(IPI 0-2,aa-IPI 0-1),the PFS of CD5+ DLBCL were significantly lower than that of CD5-group(P=0.034),while the OS had no significant difference.However,in the condition of high risk(IPI 3-5,aa-IPI 2-3),the PFS and OS of them had no obvious difference(P > 0.05).Besides,there was also no significant difference of OS and PFS between CD5+DLBCL with CD5-DLBCL in the condition of different GCB type.For the 31 CD5+DLBCL patients,.in the condition of different therapy,no statistical differences were found in PFS and OS(3 PFS 61.7% vs.66.7%,P=0.738 3 OS;75.7% vs.100%,p=0.291),indicating that the use of rituximab has no significant effect on improving the prognosis of CD5+DLBCL patients.Conclusion: 1,In the rituximab-based era.,the high PS score,LDH level and ?2-MG level,IPI score,R-IPI score and NCCN-IPI score were risk prognostic factors of survival,the NCCN-IPI better in corporated two known prognostic variables,i.e.,age and LDH,and was thus a more powerful prognosticator for high-risk subgroups DLBCL patients.2,CD5+DLBCL is more common in the elderly and more likely progress for patients with low risk(IPI 0-2 points,aa-IPI 0-1 points).The use of rituximab has no significant effect on improving the prognosis of CD5+DLBCL patients. |
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