The Addition of Ferritin Enhanced the Prognostic Value of International Prognostic Index in Diffuse Large B-Cell Lymphoma

Ziyuan Shen; Shuo Zhang; Meng Zhang; Lingling Hu; Qian Sun; Chenlu He; Dongmei Yan; Jingjing Ye; Hao Zhang; Ling Wang; Weiying Gu; Yuqing Miao; Qinhua Liu; Changli Ouyang; Junfeng Zhu; Chunling Wang; Taigang Zhu; Shuiping Huang; Wei Sang

doi:10.3389/fonc.2021.823079

The Addition of Ferritin Enhanced the Prognostic Value of International Prognostic Index in Diffuse Large B-Cell Lymphoma

Front Oncol. 2022 Jan 19:11:823079. doi: 10.3389/fonc.2021.823079. eCollection 2021.

Authors

Ziyuan Shen¹, Shuo Zhang², Meng Zhang², Lingling Hu², Qian Sun², Chenlu He¹, Dongmei Yan², Jingjing Ye³, Hao Zhang⁴, Ling Wang⁵, Weiying Gu⁶, Yuqing Miao⁷, Qinhua Liu⁸, Changli Ouyang⁹, Junfeng Zhu¹⁰, Chunling Wang¹¹, Taigang Zhu¹², Shuiping Huang^{1

13}, Wei Sang²

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, China.
² Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
³ Department of Hematology, Qilu Hospital of Shandong University, Jinan, China.
⁴ Department of Hematology, The Affiliated Hospital of Jining Medical University, Jining, China.
⁵ Department of Hematology, Taian Central Hospital, Taian, China.
⁶ Department of Hematology, The First People's Hospital of Changzhou, Changzhou, China.
⁷ Department of Hematology, Yancheng First People's Hospital, Yancheng, China.
⁸ Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
⁹ Department of Nuclear Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
¹⁰ Department of Hematology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China.
¹¹ Department of Hematology, Huai'an First People's Hospital, Huaian, China.
¹² Department of Hematology, The General Hospital of Wanbei Coal-Electric Group, Suzhou, China.
¹³ Center for Medical Statistics and Data Analysis, School of Public Health, Xuzhou Medical University, Xuzhou, China.

Abstract

Diffuse large B-cell lymphoma (DLBCL) is a highly heterogeneous non-Hodgkin lymphoma, and the prognosis of DLBCL patients is widely affected by multivariables. Clinical-factors-based prognostic systems stratify the prognosis of DLBCL with certain limitations, and the value of ferritin on the prognosis of DLBCL is unclear. In this study, 225 cases were retrieved from 4 centers of Huaihai Lymphoma Working Group (HHLWG) as the derivation cohort, and 66 cases were from the other 6 centers of HHLWG as external validation cohort. X-Tile program divided ferritin into three groups when applying 175.00 and 391.90 μg/L as the optimal cutoff points. Based on multivariable analysis, ferritin appeared to be a stronger predictor. A total of three variables (ferritin, age, and lactate dehydrogenase) were included for the development of the nomogram. The C-indexes were 0.73 and 0.70 in the derivation and validation cohort, and the calibration curve showed the consistency between the nomogram prediction and the actual observation. In conclusion, Ferritin-based nomogram enhanced the prognostic value of IPI in DLBCL.

Keywords: DLBCL; International Prognostic Index; ferritin; nomogram; prognosis.