A novel inflammation-related prognostic model for predicting the overall survival of primary central nervous system lymphoma: A real-world data analysis

Abstract

BackgroundPrimary central nervous system lymphoma (PCNSL) is a type of extranodal non-Hodgkin lymphoma. Although there are widely used prognostic scores, their accuracy and practicality are insufficient. Thus, a novel prognostic prediction model was developed for risk stratification of PCNSL patients in our research.MethodsWe retrospectively collected 122 patients with PCNSL from two medical centers in China from January 2010 to June 2022. Among them, 72 patients were used as the development cohort to construct a new model, and 50 patients were used for the validation. Then, by using univariate and multivariate Cox regression analsis and Lasso analysis, the Xijing model was developed and composed of four variables, including lesion number, β2-microglobulin (β2-MG), systemic inflammation response index (SIRI) and Karnofsky performance status (KPS). Finally, we evaluated the Xijing model through internal and external validation.ResultsCompared with the original prognostic scores, the Xijing model has an overall improvement in predicting the prognosis of PCNSL according to the time-dependent area under the curve (AUC), Harrell’s concordance index (C-index), decision curve analysis (DCA), integrated discrimination improvement (IDI) and continuous net reclassification index (NRI). For overall survival (OS) and progression-free survival (PFS), the Xijing model can divide PCNSL patients into three groups, and shows more accurate stratification ability. In addition, the Xijing model can still stratify and predict prognosis similarly better in the elderly with PCNSL and subgroups received high-dose methotrexate (HD-MTX) or Bruton’s tyrosine kinase inhibitors (BTKi). Finally, external validation confirmed the above results.ConclusionsIntegrating four prognostic factors, including imaging findings, tumor burden, systemic inflammation response index, and comprehensive physical condition, we provided a novel prognostic model for PCNSL based on real-world data and evaluated its predictive capacity.

C-reactive protein levels, the prognostic nutritional index, and the lactate dehydrogenase-to-lymphocyte ratio are important prognostic factors in primary central nervous system lymphoma: a single-center study of 223 patients

“…The involvement of inflammation in tumor progression has recently become a focal point of oncology research, as inflammation is involved in tumor growth, including shaping the microenvironment and promoting cancer cell proliferation, survival, and migration [ 18 ]. Many inflammatory parameters correlate with lymphoma prognosis, including the NLR [ 14 ], dNLR [ 19 ], lymphocyte-to-monocyte ratio [ 20 ], and SIRI [ 21 ]; however, none of these was significant associated with survival outcomes in this study.…”

“…Tejpal et al [ 34 ] found that the mean PNI significantly differed between patients with PCNSL ( n = 42) and high-grade glioma ( n = 16). A retrospective PCNSL study reported an association between the PNI and OS in the univariate analysis ( p = 0.004) but not the multivariate analysis [ 21 ]. Wong et al [ 29 ] found that the PNI impact both OS and PFS in a retrospective experiment of 41 PCNSL patients.…”

The Role of Beta2-Microglobulin in Central Nervous System Disease

“…Therefore, CSF B2M levels hold promise as an adjunctive diagnostic indicator for CNS lymphoma (Inoue et al 2023 ). Besides, in both univariate and multivariate Cox analyses, plasma B2M levels in CNS lymphoma patients was also found to be associated with prognosis (Wu et al 2023 ). These findings suggest that B2M levels in plasma might serve as an indicator for distinguishing CNS lymphoma from other types of intracranial tumors and non-CNS lymphoma, and predicting patient outcomes in CNS lymphoma.…”