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Prognostic value of POD18 combined with improved IELSG in primary central nervous system lymphoma

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Abstract

Purpose

The International Extranodal Lymphoma Study Group (IELSG) score is widely used in clinical practice to stratify the risk of primary central nervous system lymphoma (PCNSL) patients. Our study aims to confirm and improve the IELSG score in PCNSL patients based on Chinese populations.

Materials and methods

A total of 79 PCNSL patients were retrospectively analyzed. All patients treated with high-dose methotrexate (HD-MTX)-based therapy collected clinical data. The receiver-operating characteristic (ROC) curve was used to determine the optimal cut-off values for the factors in IELSG score. Progression of disease (POD) at the most landmark time point was determine by Epanechnikov kernel and the area under the ROC curve (AUROC). Kaplan–Meier and multivariable regression methods were used to analyze survival data. Nomogram was generated for calculating the weight of each selected factor.

Results

The traditional IELSG score had no significant difference on OS and PFS except ECOG ≥ 2 and could not stratify the risk groups in PCNSL. The improved IELSG scoring system was established, which incorporated age ≥ 54 years, ECOG ≥ 2, deep brain structure, elevated CSF protein, and LDH/ULN > 0.75. On the other hand, POD18 was identified as a new powerful prognostic factor for PCNSL. In multivariate analysis, POD18 and the improved IELSG scoring system were independent prognostic factors for OS. Nomogram including the two significant variables showed the best performance (C-index = 0.828).

Conclusions

In this study, the IELSG score was improved and a new prognostic indicator POD18 was incorporated to construct a nomogram prognostic model, thereby further improving the predictive ability of the model.

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Availability of data and materials

The data used and analyzed during the current study are included in the manuscript.

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Acknowledgements

Not applicable.

Funding

This work was supported by National Natural Science Foundation of China (81770166, 81720108002, and 81800192), Jiangsu Province’s Medical Elite Programme (ZDRCA2016022), Project of National Key Clinical Specialty, Jiangsu Provincial Special Program of Medical Science (BE2017751) and National Science and Technology Major Project (2018ZX09734007), Nature Science Foundation for Youths of Jiangsu Province (BK20171079), and Young Scholars Fostering Fund of the First Affiliated Hospital of Nanjing Medical University (PY2021026).

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Author notes

  1. Kai-Xin Du, Hao-Rui Shen, and Bi-Hui Pan have contributed equally to this work.

Authors and Affiliations

  1. Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

    Kai-Xin Du, Hao-Rui Shen, Bi-Hui Pan, Sibusiso Luthuli, Li Wang, Jin-Hua Liang, Yue Li, Hua Yin, Jian-Yong Li, Jia-Zhu Wu & Wei Xu

  2. Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China

    Kai-Xin Du, Hao-Rui Shen, Bi-Hui Pan, Sibusiso Luthuli, Li Wang, Jin-Hua Liang, Yue Li, Hua Yin, Jian-Yong Li, Jia-Zhu Wu & Wei Xu

  3. Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China

    Kai-Xin Du, Hao-Rui Shen, Bi-Hui Pan, Sibusiso Luthuli, Li Wang, Jin-Hua Liang, Yue Li, Hua Yin, Jian-Yong Li, Jia-Zhu Wu & Wei Xu

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Contributions

Conception: J-ZW, J-YL, and WX. Interpretation or analysis of data: K-XD and B-HP. Preparation of the manuscript: K-XD and H-RS. Revision for important intellectual content: J-ZW and WX. Supervision: LW, J-HL, YL, and HY.

Corresponding authors

Correspondence to Jia-Zhu Wu or Wei Xu.

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The authors declare no competing interests.

Ethics approval and consent to participate

This study was carried out according to the principles established by the Declaration of Helsinki and approved by the Ethical Committee of the Nanjing Medical University (the approval number: 2022-SR-040). All participants were provided with an informed consent that they signed prior to the experiments.

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12094_2023_3292_MOESM1_ESM.docx

Supplementary file1 Table S1 Reference values and the optimal cut-off values for variable. Table S2 Determination of the optimal cut-off values for early disease progression (DOCX 14 KB)

Supplementary file2 Fig. S1 Kaplan-Meier curves for PFS and OS by the whole cohort (A, B) (JPG 147 KB)

12094_2023_3292_MOESM3_ESM.jpg

Supplementary file3 Fig. S2 Kaplan-Meier curves for PFS and OS stratified by the original cut-off values of various risk factors. Factors include age ≥60 years (A, B), deep brain structure (C, D) , LDH >271 U/L (E, F) and elevated CSF protein (G, H) (JPG 3506 KB)

Supplementary file4 Fig. S3 Kaplan-Meier curves for PFS and OS according to the IELSG risk group (A, B) (JPG 1314 KB)

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Du, KX., Shen, HR., Pan, BH. et al. Prognostic value of POD18 combined with improved IELSG in primary central nervous system lymphoma. Clin Transl Oncol 26, 720–731 (2024). https://doi.org/10.1007/s12094-023-03292-5

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