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A novel prognostic model based on pretreatment serum albumin and ECOG PS for primary CNS lymphoma: an international, multi-center study

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Abstract

Background

Serum albumin has been demonstrated as prognostic parameter in non-Hodgkin lymphoma (NHL). Primary central nervous system lymphoma (PCNSL) is a rare extranodal NHL with highly aggressive behavior. In this study, we aimed at creating a novel prognostic model for PCNSL based on serum albumin levels.

Methods

We compared several commonly used laboratory nutritional parameters for predicting the survival of PCNSL patients using overall survival (OS) for outcome analysis and receiver operating characteristic curve analysis to determine the optimal cut-off values. Parameters associated with OS were evaluated by univariate and multivariate analyses. Independent prognostic parameters for OS were selected for risk stratification, including albumin ≤ 4.1 g/dL, ECOG PS > 1, and LLR > 166.8, which were associated with shorter OS; albumin > 4.1 g/dL, ECOG PS 0–1 and LLR ≤ 166.8, which were associated with longer OS, and five-fold cross-validation was used for evaluating predictive accuracy of identified prognostic model.

Results

By univariate analysis, age, ECOG PS, MSKCC score, Lactate dehydrogenase-to-lymphocyte ratio (LLR), total protein, albumin, hemoglobin, and albumin to globulin ratio (AGR) resulted statistically associated with the OS of PCNSL. By multivariate analysis, albumin ≤ 4.1 g/dL, ECOG PS > 1, and LLR > 166.8 were confirmed to be significant predictors of inferior OS. We explored several PCNSL prognostic models based on albumin, ECOG PS and LLR with 1 point assigned to each parameter. Eventually, a novel and effective PCNSL prognostic model based on albumin and ECOG PS successfully classified patients into three risk groups with 5-year survival rates of 47.5%, 36.9%, and 11.9%, respectively.

Conclusions

The novel two-factor prognostic model based on albumin and ECOG PS we propose represents a simple but significant prognostic tool for assessing newly diagnosed patients with PCNSL.

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Data availability

Data collected for this study, including individual patient data, cannot be made publicly available due to privacy/regulatory restrictions, but can be requested to the corresponding author.

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Acknowledgements

We appreciate the members of all collborative centers for helpful discussions.

Funding

The work in the You Lab is supported by The National Natural Science Foundation of China (Grant No. 81911530169). The research activities are supported by CQMU Program for Youth Innovation in Future Medicine (W0202), Talent Program of Chongqing Health Commission, and Chongqing Science and Technology Bureau (CSTB2022NSCQ-MSX0227 and cstc2022jxjl120022).

Author information

Author notes

  1. Li Wei, Yuting Gao and Katharina Theresa Prochazka have contributed equally.

Authors and Affiliations

  1. NHC Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute, Chongqing, China

    Li Wei

  2. Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China

    Li Wei

  3. Laboratory for Excellence in Systems Biomedicine of Pediatric Oncology, Department of Pediatric Hematology and Oncology, Children’s Hospital of Chongqing Medical University, 136 Zhongshan Second Rd., Yuzhong District, Chongqing, 401122, China

    Yuting Gao, Rongqiu Liu & Hua You

  4. Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, 136 Zhongshan Second Rd., Yuzhong District, Chongqing, 401122, China

    Yuting Gao, Rongqiu Liu & Hua You

  5. Clinical Department of Hematology, Medical University of Graz, Auenbruggerplatz 38, 8010, Graz, Austria

    Katharina Theresa Prochazka & Alexander J. Deutsch

  6. Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China

    Liang Wang

  7. Department of Neurosurgery Center, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China On Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory On Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China

    Boyang Liu

  8. Department of Hematology, ZhuJiang Hospital of Southern Medical University, Guangzhou, China

    Yingzhi He

  9. Pathology Unit, Department of Medical Sciences, University of Turin, Via Santena 7, 10126, Turin, Italy

    Luca Bertero & Paola Cassoni

  10. Department of Neuro-Oncology, University and City of Health and Science Hospital, Via Cherasco 15, 10126, Turin, Italy

    Alessia Pellerino

  11. Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 10068, Rome, Italy

    Luca Tamagnone

  12. Fondazione Policlinico Universitario “A. Gemelli”- IRCCS, 10068, Rome, Italy

    Luca Tamagnone

  13. Department of Hematology, the First Affiliated Hospital of Jinan University, Guangzhou, China

    Huien Zhan & Jing Lai

  14. Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea

    Seok Jin Kim

Authors
  1. Li Wei
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  2. Yuting Gao
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  3. Katharina Theresa Prochazka
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  5. Liang Wang
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  6. Boyang Liu
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  16. Hua You
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Contributions

HY designed the study and contributed to manuscript revision. LW, YG and KTP performed the research, analyzed and interpreted the data, and wrote the first draft of the manuscript. RL, LT and LB contributed to manuscript preparation and revision. LW, BL, YH, AP, PC, AD, HZ, JL, and SJK collected the data and contributed to manuscript preparation.

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Correspondence to Seok Jin Kim or Hua You.

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Wei, L., Gao, Y., Prochazka, K.T. et al. A novel prognostic model based on pretreatment serum albumin and ECOG PS for primary CNS lymphoma: an international, multi-center study. J Neurooncol 163, 301–311 (2023). https://doi.org/10.1007/s11060-023-04337-z

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