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Validation of clinical prognostic indices for diffuse large B-cell lymphoma in the National Cancer Data Base

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Abstract

Background

Accurate risk stratification is necessary for epidemiologic and outcomes research in diffuse large B-cell lymphoma (DLBCL). We evaluated performance characteristics of the clinically derived International Prognostic Index (IPI) and revised IPI (R-IPI) with a regression model-based score using the National Cancer Data Base.

Methods

We studied DLBCL patients diagnosed in 2004–2011, divided into derivation and validation cohorts. The model-based score was calculated from a Cox model incorporating variables routinely recorded by cancer registries. Calibration and discrimination of the indices with regard to overall survival were evaluated in the validation cohort.

Results

The IPI was recorded in 19,511 of 119,942 patients, of whom 79 % received chemotherapy. Both clinical indices provided good survival discrimination (5-year estimate range 33–74 % for the IPI, and 41–87 % for the R-IPI), but explained only 16 % of variation in survival. Survival predictions among chemotherapy-treated patients were similar to estimates from published clinical cohorts. The model-based score had significantly better discrimination characteristics (5-year survival estimate range 22–87 %) and explained 23 % of variation in survival.

Conclusions

We validated the IPI and R-IPI as recorded by cancer registries to provide robust risk stratification in the general population with DLBCL, but a prognostic model using raw registry data provides superior performance. Explicit recording of prognostic factors is preferable to abstracting coarsened clinical indices for the purpose of population-based epidemiologic research. Considering low variation of survival explained by the standard clinical variables, incorporating molecular markers into registry data is necessary to improve risk stratification.

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Acknowledgments

The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator. The study was funded by the authors’ academic departments.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Authors and Affiliations

  1. Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA

    Adam J. Olszewski & Eric S. Winer

  2. Division of Hematology-Oncology, Memorial Hospital of Rhode Island, 111 Brewster St., Pawtucket, RI, 02860, USA

    Adam J. Olszewski

  3. Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA

    Eric S. Winer

  4. Department of Medicine, Harvard Medical School, Boston, MA, USA

    Jorge J. Castillo

  5. Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Jorge J. Castillo

Authors
  1. Adam J. Olszewski
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Corresponding author

Correspondence to Adam J. Olszewski.

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Olszewski, A.J., Winer, E.S. & Castillo, J.J. Validation of clinical prognostic indices for diffuse large B-cell lymphoma in the National Cancer Data Base. Cancer Causes Control 26, 1163–1172 (2015). https://doi.org/10.1007/s10552-015-0610-8

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  • DOI: https://doi.org/10.1007/s10552-015-0610-8

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