Prognostic Value Of IPI、R-IPI、NCCN-IPI And GELTAMO-IPI For Diffuse Large B-cell Lymphoma

Objective:To compare the prognostic value of International Prognostic Index(IPI)、the revised International Prognostic Index(R-IPI)、 an enhanced International Prognostic Index(NCCN-IPI)and Grupo Espa(?)ol de Linfomas/Trasplante Aut(?)logo de M(?)dula (?)sea 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 according to IPI、R-IPI、NCCN-IPI and GELTAMO-IPI.Progression-free survival(PFS)and overall survival(OS)were analyzed by the Kaplan-Meier method,COX regression analysis was used to compare the risk of death and progress in each risk group.Harrell’s C statistics was used to compare the prognostic stratification ability of each model.All statistical significant were on the basis of 0.05.Results:1 Survival analysis suggested that there were differences in prognosis among IPI risk groups,especially for low-risk and low-medium-risk groups with better prognostic stratification(IPI:HR 5.085,(1.619~15.974).The overall 3-year survival rate of patients in the high-risk group was more than 50%,suggesting that the screening of patients in the high-risk group was weaker than that of NCCN-IPI and GELTAMO-IPI.The difference between the poor prognosis group and the good prognosis group of R-IPI was significantly lower than IPI.NCCN-IPI and GELTAMO-IPI only had a significant difference in prognosis between the middle-and high-risk groups,but the latter had significantly better screening ability for high-risk patients than NCCN-IPI [NCCN-IPI:HR 2.309(1.382~3.856)GELTAMO-IPI : HR 2.966(1.621~5.428)].(2)Harrell’s C statistical analysis showed that the consistency index(C-index)of the overall survival(OS)of patients undergoing R-CHOP regimen chemotherapy was 0.687,0.653,0.671 and 0.721(P<0.001),respectively.The C-index of Progression-free survival(PFS)were0.672,0.641,0.664 and 0.700(P<0.001),respectively.It was suggested that prognostic stratified model models had predictive effect,but the predictive accuracy force was located in the range of 0.5-0.7 and the accuracy was lower but relatively better than IPI、R-IPI、NCCN-IPI..Conclusion:1.The era of rituximab,although IPI could divide the patients into 4 risk groups,the prognosis of each group was significantly different.The OS and PFS of the high-risk group were still more than 50% in 3 years,which indicated that the screening ability of high-risk patients was obviously weakened.2.The prognosis difference between the poor prognosis group and the good prognosis group in each group of 2.R-IPI score is obvious,and the screening ability of high risk patients is weak,so the simple recombination of IPI clinical indicators can not improve the ability of prognosis stratification.3.The difference between middle and high risk group and high risk group was only obvious in 3.NCCN-IPI score,which may be caused by the larger proportion of elderly over 60 years old in this study,suggesting that the prognosis stratification of elderly DLBCL patients was weak;4.The differentiation ability of 4.GELTAMO-IPI score between middle and high risk group and high risk group was significantly better than that of other models,and the prognostic accuracy of stratification ability was slightly weaker than that of IPI;GELTAMO-IPI group for other risk groups.