A critical analysis of prognostic factors for survival in intermediate and high grade non-Hodgkin's lymphoma

Abstract

Between 1979 and 1987 the Scotland and Newcastle Lymphoma Group registered 972 adults with Working Formulation high or intermediate grade non-Hodgkin's lymphoma. Clinical, pathological and investigational data were recorded prospectively on a computer database allowing analysis for prognostic factors. We have derived prognostically important characteristics and have tested prospectively the validity of the prognostic index on a geographically distinct sub-set of patients from the Edinburgh/Borders clinics. Multivariate analysis showed the following factors to be important in declining order of power; advancing age, worsening performance status, CNS/liver involvement, abnormal white cell count, 'B' symptoms and advancing clinical stage. Patient individual scores allowed them to be aggregated into one of three distinct prognostic groupings separated by arbitrary cut-points into a Best Group (39%) where the median survival exceeds 5 years (53% alive at 5 years), an Intermediate Group (30%) with median survival of 21 months (21% alive at 5 years), and a Worst Group (31%) whose median survival is 7 months (8% alive at 5 years). Similar prognostic group separations occurred when analysis was confined to: patients younger than 70 years; patients treated with initial chemotherapy; patients treated with initial radiotherapy; patients within any of the major pathological sub-groups.

Diffuse Large Cell Lymphomas: Identification of Prognostic Factors and Validation of the International Non-Hodgkin’s Lymphoma Prognostic Index

“…Worsening PS (ECOG 62) was associated with an adverse prognosis for survival and RFS in studies that considered it as a potential prognostic parameter [3,11,14,16,23,26,28]. Our results are in accord with the results of these studies.…”

“…Patients who present with ß-symptoms are poor responders to chemotherapy [15,40] having also a poorer survival [23,25,27,29]. In our analysis, the presence of ß-symptoms was associated with shorter RFS and OS only in univariate analysis.…”

“…Stage is related to outcome, patients with stage III or IV disease having a poorer CR rate and survival [15,18,23,[28][29][30][31][32] as is the case in this study.…”

“…In contrast, Dixon et al [22] showed that older patients had a poorer outcome because they had poor CR rate and relapsed more often as the dose intensity received by these patients was 50% of the scheduled one. In other studies [12,13,15,[23][24][25][26][27], advanced age was associated with shorter survival. In these studies, the age found to be associated with poorer survival varied from above 60 to above 70 years.…”

Prognostic factors in the non-Hodgkin's lymphomas--a time for consensus?

“…It is against this background of a plethora of data and the practical experience of many centres and groups that we have to consider new proposals for any prognostic index, as for example that put forward by Hayward et al (1991) in this issue of the British Journal of Cancer. These authors highlight the potential difficulties in comparing the results of treating NHL in the face of 'selection pressures'.…”