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Multicentre validation of a prognostic index for overall survival in chronic lymphocytic leukaemia

Multicentre validation of a prognostic index for overall survival in chronic lymphocytic leukaemia
Multicentre validation of a prognostic index for overall survival in chronic lymphocytic leukaemia
We wish to validate in a multicentric CLL population a nomogram and a risk score recently developed to predict overall survival (OS). Complete records from 1037 CLL patients were retrospectively collected to estimate OS and time to treatment (TTT). Cox models were used to test the independence of age, ?-2-microglobulin, absolute lymphocyte count (ALC), sex, Rai stage and number of involved lymph node regions (LNR). Accuracy of prognostic models was tested with the concordance index (c-index). Median follow-up was 5.5 years, with 151 deaths and 475 treated patients. Median OS was not reached (65% survival rate at 13.9 years), median TTT was 6 years. We confirmed the ability of the prognostic score to predict OS and TTT in three risk groups, with results comparable with those reported in the original report. However, ALC and Rai stage were not independent predictors, whereas the Binet staging system, which incorporates LNR variable, showed independent predictive power; furthermore, both 5- and 10-year OS estimates from nomogram were lower compared to real data. When separately analysed, the impact of therapy on OS was not selected as independent predictor of OS in our series. According to these results, we proposed a simpler four-variable model (age, sex, Binet staging, ?-2-microglobulin) and a new nomogram. This model had a c-index of 0.78 versus 0.76 of the six-variable model (p ?= ?0.043), showing better predictive accuracy. External validation and refinement are needed on independent data sets, possibly from cancer registry patients' series.
0278-0232
91-99
Bulian, Pietro
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Tarnani, Michela
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Rossi, Davide
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Forconi, Francesco
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Del Poeta, Giovanni
ed2857f8-ebfc-4d88-96cd-21423e57738d
Bertoni, Francesco
13297a2f-854a-4841-a410-d6bfca8afee8
Zucca, Emanuele
40bd5950-d74e-4169-a2ea-0bfc1058058e
Montillo, Marco
691d7981-7b83-4b59-a653-e796c208a07c
Pozzato, Gabriele
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Deaglio, Silvia
2e20f72c-3eb1-4388-a371-8cace561211c
D'Arena, Giovanni
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Efremov, Dimitar
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Marasca, Roberto
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Lauria, Francesco
f01f163b-abcb-4aad-b952-f4356692f519
Gattei, Valter
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Gaidano, Gianluca
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Laurenti, Luca
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Bulian, Pietro
aa3b2489-d243-4e84-bcf5-fcd698f5f4ce
Tarnani, Michela
80cd5811-0b14-4244-b9d2-f8682ad96a07
Rossi, Davide
b4b2506d-794c-4c79-8b2d-6767554fd52a
Forconi, Francesco
ce9ed873-58cf-4876-bf3a-9ba1d163edc8
Del Poeta, Giovanni
ed2857f8-ebfc-4d88-96cd-21423e57738d
Bertoni, Francesco
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Zucca, Emanuele
40bd5950-d74e-4169-a2ea-0bfc1058058e
Montillo, Marco
691d7981-7b83-4b59-a653-e796c208a07c
Pozzato, Gabriele
1c9c6230-d4bd-42b7-915a-5168cd09d2d4
Deaglio, Silvia
2e20f72c-3eb1-4388-a371-8cace561211c
D'Arena, Giovanni
70024606-1ca7-4d41-ba16-1332478923a3
Efremov, Dimitar
837a37b1-755b-4027-b3c2-f0e55ab6664d
Marasca, Roberto
918148d0-8f99-4a29-8322-1b34f6d7dd00
Lauria, Francesco
f01f163b-abcb-4aad-b952-f4356692f519
Gattei, Valter
df828ae8-1b40-4acb-8908-5a6b3d16cf99
Gaidano, Gianluca
1a6a7107-107b-4891-82e0-5fedadd2f65a
Laurenti, Luca
23c6052d-80af-4fac-92da-2a495a8cb440

Bulian, Pietro, Tarnani, Michela, Rossi, Davide, Forconi, Francesco, Del Poeta, Giovanni, Bertoni, Francesco, Zucca, Emanuele, Montillo, Marco, Pozzato, Gabriele, Deaglio, Silvia, D'Arena, Giovanni, Efremov, Dimitar, Marasca, Roberto, Lauria, Francesco, Gattei, Valter, Gaidano, Gianluca and Laurenti, Luca (2011) Multicentre validation of a prognostic index for overall survival in chronic lymphocytic leukaemia. Hematological Oncology, 29 (2), 91-99. (doi:10.1002/hon.959). (PMID:20669154)

Record type: Article

Abstract

We wish to validate in a multicentric CLL population a nomogram and a risk score recently developed to predict overall survival (OS). Complete records from 1037 CLL patients were retrospectively collected to estimate OS and time to treatment (TTT). Cox models were used to test the independence of age, ?-2-microglobulin, absolute lymphocyte count (ALC), sex, Rai stage and number of involved lymph node regions (LNR). Accuracy of prognostic models was tested with the concordance index (c-index). Median follow-up was 5.5 years, with 151 deaths and 475 treated patients. Median OS was not reached (65% survival rate at 13.9 years), median TTT was 6 years. We confirmed the ability of the prognostic score to predict OS and TTT in three risk groups, with results comparable with those reported in the original report. However, ALC and Rai stage were not independent predictors, whereas the Binet staging system, which incorporates LNR variable, showed independent predictive power; furthermore, both 5- and 10-year OS estimates from nomogram were lower compared to real data. When separately analysed, the impact of therapy on OS was not selected as independent predictor of OS in our series. According to these results, we proposed a simpler four-variable model (age, sex, Binet staging, ?-2-microglobulin) and a new nomogram. This model had a c-index of 0.78 versus 0.76 of the six-variable model (p ?= ?0.043), showing better predictive accuracy. External validation and refinement are needed on independent data sets, possibly from cancer registry patients' series.

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e-pub ahead of print date: 28 July 2010
Published date: June 2011
Organisations: Cancer Sciences

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Local EPrints ID: 358125
URI: https://eprints.soton.ac.uk/id/eprint/358125
ISSN: 0278-0232
PURE UUID: ef8ca68e-4881-4df0-8457-e232824633b6

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Date deposited: 08 Oct 2013 09:26
Last modified: 18 Jul 2017 03:31

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Contributors

Author: Pietro Bulian
Author: Michela Tarnani
Author: Davide Rossi
Author: Giovanni Del Poeta
Author: Francesco Bertoni
Author: Emanuele Zucca
Author: Marco Montillo
Author: Gabriele Pozzato
Author: Silvia Deaglio
Author: Giovanni D'Arena
Author: Dimitar Efremov
Author: Roberto Marasca
Author: Francesco Lauria
Author: Valter Gattei
Author: Gianluca Gaidano
Author: Luca Laurenti

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