Prognostic nomogram for diffuse large B-cell lymphoma incorporating the International Prognostic Index with interim-positron emission tomography findings.
Intern Med J
; 43(8): 932-9, 2013 Aug.
Article
em En
| MEDLINE
| ID: mdl-23692386
ABSTRACT
BACKGROUND/AIMS:
Results from interim-positron emission tomography (PET) studies in diffuse large B-cell lymphoma (DLBCL) patients are varied. We evaluated the prognostic value of interim-PET in our centre. To improve concordance, interim-PET was combined with the International Prognostic Index (IPI).METHODS:
We retrospectively reviewed 100 new consecutive DLBCL patients treated with immunochemotherapy from 2005 to 2010. Twenty-four patients did not receive interim-PET and were excluded. Interim-PET images were re-examined using a qualitative assessment technique. Progression-free survival (PFS) and overall survival (OS) were analysed by the Cox proportional hazards model and prognostic accuracy was assessed using Harrell's C statistics (C).RESULTS:
Eleven patients were positive, and 65 were negative at interim-PET. The 2-year OS and PFS were 70.8% and 60.0%, respectively, in the PET-negative group, 36.4% and 36.4% for the PET-positive group (log-rank P-value 0.0008 for PFS, 0.0001 for OS). The IPI and interim-PET were minimally correlated. On Cox regression analysis, both were significant indicators of PFS (P < 0.001 and P = 0.002 respectively). The prognostic accuracy for PFS of a negative PET result was limited (C = 0.63), as it was for IPI (C = 0.75), but with the two indicators combined, the predictive accuracy was improved (C = 0.81). A nomogram, predictive for relapse-free survival at 2 years, was constructed.CONCLUSION:
In DLBCL patients treated with immunochemotherapy, the IPI and interim-PET provide independent prognostic information. In combination, a more powerful predictive model may be created as a nomogram. This can be refined in prospective trials and may help clinical decision making.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Linfoma Difuso de Grandes Células B
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Internacionalidade
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Tomografia por Emissão de Pósitrons
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Nomogramas
Tipo de estudo:
Diagnostic_studies
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Observational_studies
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Prognostic_studies
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Qualitative_research
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Risk_factors_studies
Limite:
Adolescent
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Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Intern Med J
Assunto da revista:
MEDICINA INTERNA
Ano de publicação:
2013
Tipo de documento:
Article
País de afiliação:
Austrália