Construction and Validation of a Novel Nomogram for Predicting the Recurrence of Diffuse Large B Cell Lymphoma Treated with R-CHOP

Abstract

Purpose

To explore recurrence-risk factors of diffuse large B cell lymphoma (DLBCL) and construct a risk nomogram for predicting recurrence.

Patients and Methods

A retrospective analysis was performed on 228 DLBCL patients who achieved complete remission after R-CHOP treatment between January 2015 and December 2019. Univariate and multivariate analyses were applied to identify recurrence-related risk factors from the pretreatment evaluation factors covering patients’ demographic characteristics, clinical manifestations, serological indicators, pathological and immunohistochemical results. A nomogram was developed based on the above results and validated by the concordance index (C-index), the receiver operating characteristic (ROC) curve, and the calibration curve.

Results

The training and validation cohorts consisted of 160 and 68 patients (randomized by 7:3). Of the whole cohort, 50 of 228 (21.9%) cases recurred during follow-up. Three recurrence-risk factors including BCL2 expression (P = 0.027), CD10 expression (P = 0.021), LDH level (P = 0.004) were identified from multivariate analysis and entered the final nomogram. The C-index of the nomogram was 0.815 in training cohort and 0.797 in the validation cohort, higher than that of IPI system (0.699) and NCCN-IPI system (0.709). And the 1-year, 2-year, 3-year, and 4-year areas under ROC (AUC) were 0.812, 0.850, 0.837, and 0.801, respectively. The calibration curves also showed a good discrimination capability and accuracy.

Conclusion

The novel nomogram incorporating the three independent risk factors (BCL2 expression, CD10 expression and LDH level) provided a valuable tool for predicting DLBCL recurrence.

Keywords:

• diffuse large B cell lymphoma
• DLBCL
• recurrence
• nomogram
• risk factors

Abbreviations

DLBCL, diffuse large B cell lymphoma; CR, complete remission; ASCT, Auto Stem Cell Transplantation; IPI, International Prognostic Index; ECOG, Eastern Cooperative Oncology Group; LDH, serum lactate dehydrogenase; β2-MG, β2 -microglobulin; PFS, progression-free survival; ROC curve, the receiver operating characteristic curve; AUROC, the area under ROC curve; C-index, the concordance index; CI, confidence interval; HR, hazard ratio; ECOG, Eastern Cooperative Oncology Group; NCCN-IPI, National comprehensive cancer network International Prognostic Index; CRP, C-reaction protein; COO, cell of origin; GCB, germinal center B-cell.

Data Sharing Statement

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Acknowledgments

We are very grateful to all the haematologists and pathologists who assisted in the collection of clinical data. We thank G. Song and J. Tang for immunohistochemical staining.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.