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A new extranodal scoring system based on the prognostically relevant extranodal sites in diffuse large B-cell lymphoma, not otherwise specified treated with chemoimmunotherapy

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Abstract

Extranodal involvement is a well-known prognostic factor in patients with diffuse large B-cell lymphomas (DLBCL). Nevertheless, the prognostic impact of the extranodal scoring system included in the conventional international prognostic index (IPI) has been questioned in an era where rituximab treatment has become widespread. We investigated the prognostic impacts of individual sites of extranodal involvement in 761 patients with DLBCL who received rituximab-based chemoimmunotherapy. Subsequently, we established a new extranodal scoring system based on extranodal sites, showing significant prognostic correlation, and compared this system with conventional scoring systems, such as the IPI and the National Comprehensive Cancer Network-IPI (NCCN-IPI). An internal validation procedure, using bootstrapped samples, was also performed for both univariate and multivariate models. Using multivariate analysis with a backward variable selection, we found nine extranodal sites (the liver, lung, spleen, central nervous system, bone marrow, kidney, skin, adrenal glands, and peritoneum) that remained significant for use in the final model. Our newly established extranodal scoring system, based on these sites, was better correlated with patient survival than standard scoring systems, such as the IPI and the NCCN-IPI. Internal validation by bootstrapping demonstrated an improvement in model performance of our modified extranodal scoring system. Our new extranodal scoring system, based on the prognostically relevant sites, may improve the performance of conventional prognostic models of DLBCL in the rituximab era and warrants further external validation using large study populations.

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Acknowledgments

This study was partly supported by a grant (2015-090) from the Asan Institute for Life Sciences, Seoul, Korea.

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Authors and Affiliations

  1. Departments of Pathology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, 05505, Korea

    Hee Sang Hwang & Jooryung Huh

  2. Departments of Oncology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, 05505, Korea

    Dok Hyun Yoon & Cheolwon Suh

Authors
  1. Hee Sang Hwang
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  2. Dok Hyun Yoon
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  4. Jooryung Huh
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Correspondence to Jooryung Huh.

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This study was approved by the Institutional Review Board of the Asan Medical Center, Seoul, Korea.

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The authors declare no conflict of interest.

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Hwang, H.S., Yoon, D.H., Suh, C. et al. A new extranodal scoring system based on the prognostically relevant extranodal sites in diffuse large B-cell lymphoma, not otherwise specified treated with chemoimmunotherapy. Ann Hematol 95, 1249–1258 (2016). https://doi.org/10.1007/s00277-016-2689-8

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