Currently, the International Prognostic Index (IPI) is the most used and reported model for prognostication in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). IPI-like variations have been proposed, but only a few have been validated in different populations (e.g., revised IPI (R-IPI), National Comprehensive Cancer Network IPI (NCCN-IPI)). We aimed to validate and compare different IPI-like variations to identify the model with the highest predictive accuracy for survival in newly diagnosed DLBCL patients. We included 5126 DLBCL patients treated with immunochemotherapy with available data required by 13 different prognostic models. All models could predict survival, but NCCN-IPI consistently provided high levels of accuracy. Moreover, we found similar 5-year overall survivals in the high-risk group (33.4%) compared to the original validation study of NCCN-IPI. Additionally, only one model incorporating albumin performed similarly well but did not outperform NCCN-IPI regarding discrimination (c-index 0.693). Poor fit, discrimination, and calibration were observed in models with only three risk groups and without age as a risk factor. In this extensive retrospective registry-based study comparing 13 prognostic models, we suggest that NCCN-IPI should be reported as the reference model along with IPI in newly diagnosed DLBCL patients until more accurate validated prognostic models for DLBCL become available.
目前，国际预后指数（IPI）是用于新诊断弥漫大B细胞淋巴瘤患者预后评估最常用且报告最广泛的模型。尽管已有类IPI改良模型被提出，但仅有少数在不同人群中得到验证（例如修订版IPI、美国国家综合癌症网络IPI）。本研究旨在验证并比较不同类IPI改良模型，以确定对新诊断DLBCL患者生存预测准确性最高的模型。我们纳入了5126例接受免疫化疗的DLBCL患者，这些患者具有13种不同预后模型所需的数据。所有模型均能预测生存，但NCCN-IPI始终表现出较高的准确性。此外，我们发现高危组的5年总生存率（33.4%）与NCCN-IPI原始验证研究结果相似。值得注意的是，仅有一个纳入白蛋白指标的模型表现出相当效果，但在区分度方面未超越NCCN-IPI（c指数0.693）。仅包含三个风险组且未将年龄作为风险因素的模型在拟合度、区分度和校准方面表现欠佳。在这项基于大规模回顾性注册数据、比较13种预后模型的研究中，我们建议在新诊断DLBCL患者中应将NCCN-IPI与IPI共同作为参考模型进行报告，直至出现更精准的DLBCL验证预后模型。
肿瘤(癌症)患者之家