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Molecular Diagnostics

A nomogram prognostic index for risk-stratification in diffuse large B-cell lymphoma in the rituximab era: a multi-institutional cohort study

British Journal of Cancer volume 125, pages 402–412 (2021)Cite this article

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Abstract

Background

We aimed to establish a predictive prognostic risk-stratification model for diffuse large B-cell lymphoma (DLBCL) in the rituximab era.

Methods

The data of 1406 primary DLBCL patients from the Sun Yat-Sen University Cancer Center were analysed to establish a nomogram prognostic index (NPI) model for predicting overall survival (OS) based on pre-treatment indicators. An independent cohort of 954 DLBCL patients from three other hospitals was used for external validation.

Results

Age, performance status, stage, lactate dehydrogenase, number of extranodal sites, BCL2, CD5 expression, B symptoms and absolute lymphocyte and monocyte count were the main factors of the NPI model and could stratify the patients into four distinct categories based on their predicted OS. The calibration curve demonstrated satisfactory agreement between the predicted and actual 5-year OS of the patients. The concordance index of the NPI model (0.794) was higher than the IPI (0.759) and NCCN-IPI (0.750), and similar results were obtained upon external validation. For CD5 + DLBCL patients, systemic treatment with high-dose methotrexate was associated with superior OS compared to R-CHOP-based immunochemotherapy alone.

Conclusions

We established and validated an accurate prediction model, which performed better than IPI and NCCN-IPI for prognostic stratification of DLBCL patients.

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Fig. 1: Construction of the NPI model and calibration curve of NPI model.
Fig. 2: NPI model to predict overall survival in DLBCL patients.
Fig. 3: Comparison of the predictive performance between NPI, IPI and NCCN-IPI models.
Fig. 4: Kaplan–Meier survival analysis of overall survival stratified by treatment.

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Acknowledgements

We would like to thank all the physicians for their actively cooperating with us in collecting patient information, thank all the patients and their families for allowing us to analyse their data.

Author information

Author notes

  1. These authors contributed equally: Jun Cai, Xiaopeng Tian, Shuyun Ma, Liye Zhong, Wenyu Li

Authors and Affiliations

  1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China

    Jun Cai, Xiaopeng Tian, Shuyun Ma, Huiqiang Huang, Zhongjun Xia, Yi Xia, Panpan Liu, Ning Su, Yu Fang, Yuchen Zhang & Qingqing Cai

  2. Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China

    Jun Cai, Xiaopeng Tian, Shuyun Ma, Huiqiang Huang, Yi Xia, Panpan Liu, Ning Su, Yu Fang, Yuchen Zhang & Qingqing Cai

  3. Department of Hematology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, P. R. China

    Liye Zhong

  4. Lymphoma Division, Cancer Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, P. R. China

    Wenyu Li

  5. Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, P. R. China

    Liang Wang

  6. Department of Pathology, Zhujiang Hospital, Southern Medical University, Guangzhou, P. R. China

    Linlang Guo

  7. Department of Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China

    Zhihua Li & Yudan Wu

  8. Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China

    Guangzheng Zhong

  9. Department of Hematology Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China

    Zhongjun Xia

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Contributions

J.C., X.P.T., S.Y.M., L.Y.Z. and W.Y.L. contributed to study design, statistical analysis and figure and tables preparation. L.Y.Z., W.Y.L., L.W., L.L.G., Z.H.L., Y.D.W., G.Z.Z., N.S., Y.F., Y.C.Z. and P.P.L. performed data collecting. J.C., X.P.T., S.Y.M. and Q.Q.C. performed manuscript writing and reviewing. Q.Q.C. conceived and designed this study that led to the submission, acquired the data and played an important role in interpreting the results, she is also responsible for all aspects of the work to sure that all questions of the work are appropriately investigated and resolved. All authors agree with the contents of this manuscript.

Corresponding author

Correspondence to Qingqing Cai.

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Ethics approval and consent to participate

Written informed content for all patients was provided. Ethical approval of the dataset used for this project was obtained from The Institutional Review Board of Sun Yat-sen University Cancer Center (Guangzhou, China, No. B2020–235–01). The study was performed in accordance with the Declaration of Helsinki.

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Data availability

The authenticity of this article has been validated by uploading the key raw data onto the Research Data Deposit public platform (www.researchdata.org.cn), with the approval RDD number as RDDA2020001739.

Competing interests

The authors declare no competing interests.

Funding information

This work was supported by the National Natural Science Foundation of China (81672686), Special Support Program of Sun Yat-sen University Cancer Center (PT19020401), Science and Technology Planning Project of Guangzhou, China (202002030205) and Clinical Oncology Foundation of Chinese Society of Clinical Oncology (Y-XD2019–124).

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Cai, J., Tian, X., Ma, S. et al. A nomogram prognostic index for risk-stratification in diffuse large B-cell lymphoma in the rituximab era: a multi-institutional cohort study. Br J Cancer 125, 402–412 (2021). https://doi.org/10.1038/s41416-021-01434-6

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