Retrospective Analysis of Clinical Characteristics and Prognostic Factors in Patients with Diffuse Large B-Cell Lymphoma
WANG Lihua
GUO Yan
YANG Man
ZI Youmei
ZHU Luyao
TIAN Linlin
ZHANG Yuan
Abstract：Objective To analyze the correlations among clinical manifestations,molecular subtypes and prognosis in patients with diffuse large B-cell lymphoma(DLBCL),verify the prognostic value of the traditional international prognostic index(IPI)and its individual components in the era of rituximab plus CHOP(R-CHOP)regimen,and explore a modified risk stratification model incorporating extranodal involvement and molecular subtypes,so as to provide evidence for clinical prognostic evaluation and individualized treatment.Methods A retrospective analysis was conducted on the clinical data of 120 previously untreated DLBCL patients admitted to the First Affiliated Hospital of Henan Medical University from January 2020 to January 2023.Patients' demographic characteristics,Ann Arbor staging,number of extranodal involvement,lactate dehydrogenase(LDH)level,Eastern Cooperative Oncology Group(ECOG)score,IPI score,immunohistochemical molecular typing[germinal center B-cell-like(GCB),non-germinal center B-cell-like(non-GCB)],and survival follow-up information were systematically collected.The Kaplan-Meier method was used to calculate the 3-year overall survival(OS)and progression-free survival(PFS),and the log-rank test was used for inter-group comparison.Variables with P＜0.1 in univariate analysis were included in the Cox proportional hazards regression model,and multivariate models including the total IPI score(model 1)and individual IPI components(model 2)were constructed,respectively,with proportional hazards hypothesis testing.Subgroup analysis was further conducted based on molecular typing,and a simple prognostic score incorporating independent risk factors was preliminarily constructed.Results The median follow-up time for the entire group of 120 patients was 36 months.The 3-year OS was 69.2％,and the 3-year PFS was 62.5％.Univariate analysis showed that age(＜40 years,40-＜60 years,≥60 years),Ann Arbor stages Ⅲ and Ⅳ,IPI score ≥ 3,elevated LDH,≥2 extranodal involvements,and non-GCB molecular subtypes were significantly associated with poorer OS and PFS(P＜0.05).Multivariate analysis(model 1)revealed that an IPI score of ≥3(HR=3.448,95％CI:1.820-6.352,P＜0.001),≥2 extranodal involvements(HR=2.759,95％CI:1.480-5.146,P=0.001),and non-GCB subtype(HR=1.986,95％CI:1.132-3.485,P=0.017)were independent poor prognostic factors for OS.Model 2(individual components of IPI)indicated that only ≥2 extranodal involvements(HR=2.815,95％CI:1.513-5.237,P=0.001)and elevated LDH levels(HR=1.892,95％CI:1.056-3.391,P=0.032)maintained independent prognostic significance.Subgroup analysis found that the impact of age on prognosis was primarily concentrated in the non-GCB subtype(HR=2.436,95％CI:1.284-4.622,P=0.007).The initially constructed simplified prognostic model incorporating three factors(IPI score≥3,≥ 2 extranodal involvements,and non-GCB subtype)showed a trend toward better discrimination for 3-year overall survival compared with the traditional IPI score.Conclusion High IPI score,multiple extranodal involvements,and non-GCB subtype are independent poor prognostic factors for DLBCL patients;the contribution of traditional IPI components has decreased,with extranodal involvement and elevated LDH levels gaining more prominence;there is a significant interaction between age and molecular typing.The simplified modified model constructed based on these factors exhibits superior discriminatory power compared to the traditional IPI.This study provides a scientific basis for individualized prognostic assessment and identification of high-risk patients in DLBCL.
Keywords：diffuse large B-cell lymphomaclinical characteristicsprognostic factorsretrospective studyoverall survival
Publication Date：2026-08-13
Online Publishing Date：2026-09-12(First online date of this platform, not the publication date of the document)
Pages：5( 2722-2726 )