Evidence of time‐dependent prognostic factors predicting early death but not long‐term outcome in primary CNS lymphoma: a study of 91 patients
Hervé GhesquièresYouenn DrouetMarie Pierre SunyachCatherine SebbanCatherine Chassagne‐ClémentEmmanuel JouanneauJérôme HonnoratPierre BironJean‐Yves Blay
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Abstract:
Long-term primary CNS lymphoma (PCNSL) survivors could have multiple adverse prognostic factors at diagnosis such as age, performance status (PS), site of the tumour (deep vs superficial), lactate dehydrogenase (LDH) level and CSF protein level. Whether these five prognostic factors integrated in the International Extranodal Lymphoma Study Group (IELSG) score have a time-dependent effect is questionable. Among 132 PCNSL patients treated at our institution between 1984 and 2006, 91 available patients for IELSG score were evaluated by time-segmented analysis. Of the 91 patients, 21% had 0-1, 59% had 2-3 and 20% had 4-5 adverse IELSG prognostic scores. With a median follow-up of 102 months, the median overall survival (OS) of the 91 patients with the five prognostic factors of IELSG score was 33 months (95% CI, 17 to 55) compared with 14 months (95% CI, 3 to 23) for the remaining 41 patients whose CSF protein level was lacking in the IELSG score. These 41 patients who did not have lumbar puncture presented a poorer PS at diagnosis and a lower treatment response rate. While confirming the prognostic value of the IELSG score, we observed a time-dependent effect of age, PS and tumour site; all three lost their prognostic value after 6 months from diagnosis, while LDH remained a constant predictor of OS. No prognostic impact of CSF protein level was reported. Patients with older age, poor PS and deep brain involvement are at risk of death during the first months after diagnosis but could have a favourable long-term outcome after the treatment period. New prognostic factors predicting long-term outcome remain to be determined.Keywords:
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International Prognostic Index
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Whole brain radiotherapy
Recursive partitioning
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Univariate
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Consecutive series involving 172 patients with small cell lung cancer were analyzed retrospectively using eight pretreatment and two treatment-related prognostic factors in respect of their influence on survival. All the patients received chemotherapy with or without chest irradiation, according to phase II or phase III trial protocols of the National Cancer Center Hospital, Tokyo, from 1970 to 1987. The influence on survival of the various factors was investigated using univariate methods and Cox's proportional hazards model. In patients who survived for more than one year, a performance status of 0-1, limited disease, an age greater than 60 years, the absence of liver metastasis, radiotherapy to primary site and response to chemotherapy were determined by univariate analysis to be favorable prognostic factors. By multivariate analysis, performance status (P = 0.005), age (P = 0.026) and response to induction chemotherapy (P = 0.0001) proved to be valuable prognostic survival factors. The extent of disease which had been considered one of the most significant prognostic factors, was shown not to be a significant independent variable by multivariate analysis. Staging procedures may influence the prognostic analysis. Although classifying the limited or extensive stage of disease is still recommended, the current staging system lacks stringency and may not, in fact, reflect the tumor burden accurately. A simpler and meaningful staging system needs to adopted universally in order to continue the build-up of data for comparison from all institutions.
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Purpose. Validation of a Canadian three-tiered prognostic model (survival prediction score, SPS) in Norwegian cancer patients referred for palliative radiotherapy (PRT), and evaluation of age-dependent performance of the model. Patients and Methods. We analyzed all 579 PRT courses administered at a dedicated PRT facility between 20.06.07 and 31.12.2009. SPS was assigned as originally described, That is, by taking into consideration three variables: primary cancer type, site of metastases, and performance status. Results. Patients with poor prognosis (non-breast cancer, metastases other than bone, and Karnofsky performance status (KPS) ≤ 60) had median survival of 13 weeks. Those with intermediate prognosis (two of these parameters) survived for a median of 29 weeks, and patients with good prognosis for a median of 114 weeks, P < 0.001. While this model performed well in patients who were 60 years or older, it was less satisfactory in younger patients (no significant difference between the good and intermediate prognosis groups). Conclusion. SPS should mainly be used to predict survival of elderly cancer patients. However, even in this group accuracy is limited because the good prognosis group contained patients with short survival, while the poor prognosis group contained long-term survivors. Thus, improved models should be developed.
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To predict the prognostic factors and to improve the response and survival in intermediate-grade and high-grade non-Hodgkin lymphoma (NHL).200 patients with intermediate-grade and high-grade NHL were treated with chemotherapy. A multivariate Cox model was used to analyse the prognostic factors that significantly affect the treatment outcome. The variables examined included: sex, age, clinic stage of disease, B symptoms, extranodal sites, bone marrow involvement, tumor bulk, performance status (ECOG) and malignancy grades.Multivariate analysis showed that performance status, the number of extranodal sites, pathologic malignancy grade and tumor bulk were significantly independent prognostic factors. These factors were put together to construct a prognostic index formula. The index partitioned the patients into low risk group (PI -2.43(-)-1.30), intermediate risk group (PI -1.29-1.0) and high risk group (PI > 1.0) giving 5-year survival rates of 76.0%, 21.6% and 7.4%, respectively.The prognostic index formula and subgroups could serve as a reference to distinguish patients requiring more intensive chemotherapy and autologous stem cell transplantation from those who should be treated with standard regimens in order to improve the prognosis.
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