Decreased Prognostic Value of International Prognostic Score in Chinese Advanced Hodgkin Lymphoma Patients Treated in the Contemporary Era

Abstract

Background:The International Prognostic Score (IPS) was developed based on the data of Western advanced Hodgkin lymphoma (HL) patients treated before 1992. Only a few studies ever evaluated the application value of IPS in Chinese population or in patients treated in the contemporary era whose outcomes has improved significantly than before.Methods:We conducted a retrospective study involving 208 previously untreated Chinese advanced HL patients, who were admitted to Cancer Hospital Chinese Academy of Medical Sciences from January 1, 1999 to April 30, 2015 and received uniform first-line treatment. The prognostic value of both IPS and the seven IPS factors for freedom-from progression (FFP) and overall survival (OS) was assessed in this population. The statistical methods included Kaplan-Meier methodology, log-rank testing, and Cox proportional hazard regression analysis.Results:With a median follow-up time of 79 months (range, 15–210 months), the 5-year FFP and OS were 78.8% and 86.0% respectively, which improved obviously compared with the original IPS study. The IPS remained prognostic for both FFP (P = 0.041) and OS (P = 0.013), but the range narrowed obviously, with 5-year FFP ranging from 87.2% to 61.5%, 5-year OS ranging from 94.1% to 69.2%, and the separation of survival curves was not as good as before. Only two of the seven IPS factors showed a significant independent prognostic value in the multivariate analysis: Stage IV (for FFP, hazard ratio [HR] = 2.219, 95% confidence interval [CI]: 1.148–3.948, P = 0.016; for OS, HR = 2.491, 95% CI: 1.159–5.355, P = 0.019) and hemoglobin <105 g/L (for FFP, HR = 2.136, 95% CI: 1.123–4.060, P = 0.021; for OS, HR = 2.345, 95% CI: 1.099–5.042, P = 0.028). A simple prognostic score calculated by adding one point each for any of the two factors was prognostic both for FFP (P < 0.001) and OS (P < 0.001) with the survival curves separating very well, but the range still narrowed.Conclusions:The IPS has decreased the prognostic value in Chinese advanced HL patients treated in the contemporary era. More prognostic factors are needed to supplement this original scoring system so as to identify different risk populations more accurately.

Clinical characteristics and prognostic factors in Chinese patients with classical Hodgkin’s lymphoma involving extranodal sites: a retrospective single-center study

“…But these studies including a small group of patients and didn't analyze cHL alone. Some other studies also found anemia [22], eosinophilia [23], elevated β2-microglubin [19] and elevated serum ferritin [24] to be adverse factors. Thus, our study analyzed all the factors above that could be collected, and then included factor with p-value < 0.100 into multivariate analysis.…”

Prognostic Factors for Clinical Outcomes in Patients with Newly Diagnosed Advanced-stage Hodgkin Lymphoma: A Nationwide Retrospective Study

“…However, the data from two Chinese cohorts did not reveal a comparable conclusion, where younger patients with HL did not necessarily have better FFP than elderly patients. 10 , 21 Diverse age distribution among different study cohorts could be one explanation for this data discrepancy. Approximately 20% of patients were aged ≥60 years in the current study.…”

“…This could explain our results, which were further validated by other analyses, showing that stage IV was related to worse FFP and OS. 9 , 10 …”

“…The survival of HL has also improved, and the differences across risk groups have diminished. 8 - 10 One example comes from the report of the Spanish study group, showing Stage IV and age >45 years were the only prognostic factors of the IPS for the outcome of advanced HL. 11 To improve the predictive ability of IPS-7, Diefenbach et al proposed IPS-3, which comprises age, stage, and hemoglobin level.…”

Comparison of ALC, LMR and IPS in predicting Prognosis in Hodgkin lymphoma

“…For IPS: we could not study the best cut-off point suitable for our patients because the pilot study data did not include Albumin analysis results. Therefore, we relied on what is found in the medical literature, we considered that IPS of 3 represent the best cut-off point [9,10].…”