A novel prognostic model based on ferritin and nomogram-revised risk index could better stratify patients with extranodal natural killer/T-cell lymphoma

Xindi Liu; Yuanzheng Liang; Ziyuan Shen; Liqiang Wei; Jing Yang; Yingshi Piao; Wei Sang; Pengfei Li; Liang Wang

doi:10.1002/cam4.5820

A novel prognostic model based on ferritin and nomogram-revised risk index could better stratify patients with extranodal natural killer/T-cell lymphoma

Cancer Med. 2023 May;12(9):10660-10671. doi: 10.1002/cam4.5820. Epub 2023 Mar 16.

Authors

Xindi Liu¹, Yuanzheng Liang¹, Ziyuan Shen², Liqiang Wei¹, Jing Yang¹, Yingshi Piao^{3

4}, Wei Sang⁵, Pengfei Li⁶, Liang Wang¹

Affiliations

¹ Department of Hematology, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
² Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.
³ Department of Pathology, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
⁴ Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
⁵ Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
⁶ Department of Oncology, Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China.

Abstract

Background: Extranodal natural killer (NK)/T-cell lymphoma (ENKTCL) is an aggressive lymphoma with marked heterogeneity, resulting in a distinct prognosis even in patients with the same disease stage. The nomogram-revised risk index (NRI) has been proposed to stratify patients with ENKTCL. Numerous reports have revealed the prognostic role of serum ferritin in various cancers.

Purpose: We aimed to evaluate the role of NRI in our single cohort of patients with ENKTCL treated uniformly, explore the prognostic value of ferritin, and establish a new prognostic model to better stratify patients with ENKTCL.

Methods: We included 326 patients with ENKTCL with detailed data regarding clinical characteristics and survival outcomes. All patients were treated with asparaginase-based chemotherapy with or without radiotherapy. Multiple R packages were used to analyze the prognostic factors and derive a novel prognostic model.

Results: In the training cohort comprising 236 patients with ENKTCL, NRI significantly correlated with progression-free survival (PFS) and overall survival (p < 0.0001). Using a ferritin level of 400 μg/L as the cutoff value, patients with high ferritin levels had significantly inferior PFS (p = 0.00028). Integrating the NRI score and four easily accessible clinical parameters, namely ferritin, hemoglobin, albumin, and D-dimer, a new prognostic model was constructed, stratifying patients with ENKTCL into three risk groups. This new prognostic model was independent of disease stage and NRI and performed better than NRI. Furthermore, this model helped to stratify patients within the same NRI risk groups. Finally, the role of this novel prognostic model was validated in the external validation cohort comprising 90 patients with ENKTCL.

Conclusions: Serum ferritin level could be a novel prognostic factor in patients with ENKTCL. The new prognostic model combining NRI and clinical parameters could better predict the prognosis of ENKTCL, thereby warranting further validation and potentially guiding individualized treatment in future prospective clinical trials.

Keywords: extranodal NK/T-cell lymphoma; ferritin; individualized treatment; nomogram-revised risk index; prognostic model.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cohort Studies
Female
Ferritins* / blood
Humans
Lymphoma, Extranodal NK-T-Cell* / diagnosis
Lymphoma, Extranodal NK-T-Cell* / drug therapy
Lymphoma, Extranodal NK-T-Cell* / radiotherapy
Male
Middle Aged
Neoplasm Staging
Nomograms
Progression-Free Survival
Risk Assessment

Substances

Ferritins