The Impact of Surgery on Long-Term Survival of Patients with Primary Gastric Diffuse Large B-Cell Lymphoma: A SEER Population-Based Study

A Novel and Validated Inflammation-Based Prognosis Score (IBPS) Predicts Outcomes in Patients with Diffuse Large B-Cell Lymphoma

Purpose

We aimed to create a novel prognostic score, the inflammation-based prognosis score (IBPS). In addition, we attempted to establish and validate a nomogram to predict the overall survival (OS) of patients with DLBCL.

Patients and Methods

We retrospectively investigated the data of 213 patients with DLBCL diagnosed and treated in the Affiliated Hospital of Jiangnan University and used these data to develop nomograms. At the same time, 89 patients diagnosed and treated in Wuxi People's Hospital Affiliated with Nanjing Medical University from January 2015 to June 2021 were collected as an external validation cohort. We developed IBPS through the least absolute shrinkage and selection operator (LASSO) Cox regression. The univariate and multivariate Cox regression method was used to develop the nomogram. We used the concordance index (C-index), calibration chart, time-dependent receiver operating characteristic (ROC) analysis, decision curve analysis (DCA), and the Kaplan-Meier curve were used to assess the nomogram.

Results

The systemic immune inflammation index (SII), prognostic nutrition index (PNI), and modified Glasgow prognostic score (mGPS) were used to construct IBPS. The Eastern Cooperative Oncology Group performance status (ECOG PS), IBPS, response to treatment, and whether accept surgery were used to construct the nomogram to predict the OS of DLBCL patients. The C-index in the training and validation cohorts were 0.844 and 0.828, respectively. According to the time-dependent ROC curve and DCA, the nomogram has good predictive accuracy and clinical net benefit. The Kaplan-Meier curve showed that according to the nomogram score, patients in the training and validation cohorts could be classified into three risk groups.

Conclusion

In patients with DLBCL, baseline IBPS was a reliable predictor of OS. The survival probability of DLBCL patients can be precisely predicted using the prognosis nomogram based on IBPS.

Prognostic effects of clinical parameters, genetic abnormalities, and subtypes in primary gastric diffuse large B-cell lymphoma: a cohort analysis of 146 patients

This study included 146 primary gastric diffuse large B-cell lymphoma patients. Next-generation RNA sequencing and fluorescent in situ hybridization were performed on tumors from 27 and 38 patients, respectively. Five-year and 10-year overall survival (OS) rates were 77% and 57%, respectively. Lugano and TNM clinical stage were independent survival factors. Tier I mutation was found in 21 patients. The genetic subtypes were A53 (n = 3), MCD (n = 5), BN2 (n = 5), N1 (n = 5), EZB (n = 1), and NOS (n = 8). OS was significantly shorter in high-risk genetic subtypes (A53, MCD, and N1) than low-risk subtypes (BN2, EZB, and NOS). Frequencies of high-risk genetic subtypes were higher in patients with Lugano stage II/IV and TNM clinical stage III + IV than in those with Lugano stage I and TNM clinical stage I + II. Although genetic testing was performed in only a small number of cases, the results suggested that high-risk genetic subtypes were associated with advanced clinical stages and shorter survival.

The influence of marital status on survival in patients with nasopharyngeal carcinoma: A surveillance, epidemiology, and end results database analysis

BACKGROUND

To assess the influence of marital status on the survival of patients with nasopharyngeal carcinoma (NPC), we used the Surveillance, Epidemiology, and End Results (SEER) database to analyze 5477 patients who were diagnosed with NPC from 2004 to 2016.

METHODS

Kaplan-Meier survival analysis and Cox proportional hazard regression were used to analyze the influence of marital status on cause-specific survival (CSS) and overall survival (OS). Subgroup analyses was used to assess the influence of marital status on CSS based on different factors.

RESULTS

For the 5477 patients, 61.5%, 22.4%, and 16.1% were married, single/unmarried, and separated/widowed/divorced, respectively. The separated/widowed/divorced group was more likely to be female (P < .001), had the highest proportion of elderly subjects (P < .001), were mostly Caucasian (P < .001), had pathological grade I/II (P < .001), were likely to undergo surgery (P = .032), and were registered in the northeast, north-central, and south (P < .001) regions. The 5-year CSS rates were 92.6%, 92.4%, and 85.1% in the married, single/unmarried, and separated/widowed/divorced groups, respectively (P < .001), and the 5-year OS rates were 60.7%, 54.6%, and 40.1%, respectively (P < .001).

CONCLUSION

Marital status is an independent prognostic factor of NPC. Separated/widowed/divorced patients had a significantly increased risk of NPC-related death (hazard ratio [HR] = 2.180, 95% confidence interval [CI] 1.721-2.757, P < .001) compared to married patients. The single/unmarried (P = .355) group had a CSS similar to that of the unmarried group. Marital status is an independent prognostic factor of survival in NPC patients. Separated/widowed/divorced status increases the risk of NPC mortality.

Predictors and Long-Term Outcomes for Diffuse Large B-Cell Lymphoma (DLBCL) Patients Undergoing Surgery Prior to Systemic Therapy: A Nationwide Analysis

BACKGROUND

A minority of patients diagnosed with diffuse large B-cell lymphoma (DLBCL) undergo surgery before the initiation of systemic therapy. The aim of this study is to explore the characteristics of patients undergoing surgery prior to systemic therapy (surgfirst), the predictors for surgfirst, and the survival outcomes.

METHODS

The National Cancer Database was queried for patients with DLBCL diagnosed between 2006 and 2015, and we performed a subgroup analysis of patients that received surgfirst. Time-to-initial therapy (TTI) was defined as the time in days (d) from diagnosis to systemic therapy. Overall survival was measured from the day of diagnosis in terms of months (m).

RESULTS

Factors associated with lower likelihood of surgfirst were non-Hispanic Black race (p-value<0.005), rural location (p-value<0.005), treatment at academic center (p-value<0.005), Medicaid insurance (p-value=0.01), comorbidity score >=3 (p-value 0.007), year of diagnosis, advanced stages of disease, and presence of B-symptoms. The TTI of systemic therapy was delayed in the surgfirst group - 34 (IQR 22-52) days vs. 23 (IQR 13-38) days, p-value<0.005. The five-year overall survival was 62.7% (95% CI 62.1-63.2%) vs. 58.3% (95% CI 57.7-60.0%) - HR 0.87 (95% CI 0.85-0.89), p-value<0.005. The factors associated with higher mortality were advanced comorbidities, lower educational status, disease primarily located in the bone, brain, and spinal cord, advanced clinical stage, presence of B-symptoms, and advanced age.

CONCLUSION

Despite the delay in systemic therapy, we could not identify a detrimental impact of surgfirst on survival. This needs to be confirmed in large-scale multicenter studies. We identified clinical and socioeconomic factors that affect treatment selection and survival.

Gastric Diffuse Large B-Cell Lymphoma: A Single-Center 9-Year Experience

Gastric diffuse large B cell lymphoma (DLBCL) represents the majority of all gastric lymphomas. We report a series of gastric DLBCL diagnosed and treated in a single center, between 2010 and 2018 (included). We retrospectively analyzed the population demographic features, treatment outcomes and survival. One-hundred-and-one patients were studied, 50.5% males and median age of 64 years [23–94]. Lugano staging was I in 16.8%, II1 in 20.8%, II2 in 10.9%, IIE in 13.9% and IV in 34.7% of cases. Twenty percent had Helicobacter pylori infection. R-CHOP-like therapy was used as first line in 96.9% of the patients. A complete response was achieved in 80% after first line therapy. At 3-years of follow-up (FU), 54% were in complete remission. The mean FU time was 73.6 months. Median overall survival and median progression free survival were not reached. We identified seven factors with negative impact in survival: age above 65 years-old (p < 0.01), ECOG 2–3 (p < 0.01), B symptoms (p = 0.001), bulky disease (p = 0.003), IPI 3–4 (p = 0.001), more than 3 treatment lines (p < 0.01), absence of response to first line treatment (p < 0.01). This study demonstrates that gastric DLBCL is a potentially curable disease with R-CHOP-like therapy, entailing long term survival and comparing well with other published series.

Dynamic prediction of long-term survival in patients with primary gastric diffuse large B-cell lymphoma: a SEER population-based study

Background

This study investigated a large number of patients to develop a predictive nomogram for survival and a web-based survival rate calculator that can dynamically predict the long-term survival of patients with primary gastric diffuse large B-cell lymphoma.

Methods

A total of 2647 patients diagnosed with primary gastric diffuse large B-cell lymphoma from 1998 to 2014 were extracted from the SEER database. We used the Lasso Cox regression model to identify independent risk factors for long-term survival and to develop a predictive nomogram for survival and a web-based survival rate calculator.

Results

The median (mean) follow-up time was 30 months (52.8 months). Cancer-specific survival rates decreased with time, while the 5-year conditional survival increased with time. Cancer-specific deaths were not constant. Cancer-specific deaths of patients within the first 2 years were high, while the risk remained relatively constant after 2 years. The independent risk factors included surgery, chemotherapy, tumor stage and age, according to the Lasso Cox regression analysis. We developed a predictive nomogram and a web-based survival rate calculator (https://linjuli1991.shinyapps.io/dynnomapp/). The calibration plot suggested that the actual value exhibited good agreement with the predicted value.

Conclusions

We found that patients with primary gastric diffuse large B-cell lymphoma had a high risk of death during the first 2 years. Additional active follow-up strategies should be provided during this period. This is the first study to develop a predictive nomogram and a web-based survival rate calculator that can provide evidence for individual treatment and follow-up.

Electronic supplementary material

The online version of this article (10.1186/s12885-019-5993-6) contains supplementary material, which is available to authorized users.