China Oncology ›› 2020, Vol. 30 ›› Issue (6): 449-455.doi: 10.19401/j.cnki.1007-3639.2020.06.007

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Retrospective analytical study on clinical features and prognostic models in patients with head and neck diffuse large B-cell lymphoma

ZHANG Yan, TANG Yong, YAO Yiyun, ZOU Lifang, DOU Hongju, ZHU Qi   

  1. Department of Hematology, Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
  • Online:2020-06-30 Published:2020-07-16
  • Contact: ZHU Qi E-mail: zhuqi70@hotmail.com

Abstract: Background and purpose: Head and neck diffuse large B-cell lymphoma (HN-DLBCL) is one of the most common aggressive non-Hodgkin's lymphoma involving this anatomical site. With the clinical application of rituximab-containing immunochemotherapy and local radiotherapy as well as cellular immunotherapy, treatment outcomes of HN-DLBCL patients, including not only rates of response, but also progression-free survival (PFS), have been dramatically improved. However, a number of patients become relapsed/refractory cases. Previous clinical studies showed that risk-adapted treatment strategies could allow prompt and tailored intervention for high-risk patients thereby significantly reducing probabilities of being relapsed or refractory cases. The present study aimed to systematically analyze clinical features and their prognostic values in HN-DLBCL patients and compare stratification efficacies of different prognostic models. Methods: A total of 134 patients with HN-DLBCL in Shanghai Ninth People’s Hospital from Jan. 2010 to Dec. 2018 were retrospectively identified and systemically analyzed. Survival curves were estimated by using Kaplan-Meier survival methodology. The prognostic influences of clinical factors on survival were studied by univariate log-rank test and multivariate Cox proportional hazards regression models. Three prognostic models including International Prognostic Index (IPI), National Comprehensive Cancer Network-IPI (NCCN-IPI) and Spanish Lymphoma/Autologous Bone Marrow Transplant Working Group-IPI (GELTAMO-IPI) were applied for risk stratification to compare 3-year survival rates among patients in different risk groups. Results: Univariate analysis identified prognostic factors for HN-DLBCL patients, including Ann Arbor stage, non-germinal center B-cell (non-GCB) subtype, serum lactate dehydrogenase (LDH) and β2 microglobulin value, while multivariate Cox regression analysis revealed that serum LDH level was the independent prognostic indicator. The predicted 3-year overall survival (OS) of high-risk HN-DLBCL patients stratified by IPI, NCCN-IPI and GELTAMO-IPI were 44.7%, 36.8% and 32.8%, while their 3-year PFS were 44.3%, 20.7% and 16.3%, respectively. NCCN-IPI and GELTAMO-IPI demonstrated enhanced discrimination compared with IPI for high-risk HN-DLBCL cases [3-year PFS (IPI vs NCCN-IPI vs GELTAMO-IPI): 44.3% vs 20.7% vs 16.3%]. Conclusion: In immunochemotherapy era, LDH level was an independent prognostic factor in HN-DLBCL patients. Modified prognostic models including NCCN-IPI and GELTAMO-IPI might be more powerful than IPI in predicting high-risk patients.

Key words: Diffuse large B-cell lymphoma, Head and neck, Prognosis, Survival rate