Open AccessTransformation Scoring System (TSS): A new assessment index for clinical transformation of follicular lymphoma
Author(s) -
Shichijo Takafumi,
Maruyama Dai,
Yamauchi Nobuhiko,
Maeshima Akiko Miyagi,
Sugano Masato,
Yuda Sayako,
Tajima Kinuko,
Kurihara Hiroaki,
Shimada Kaoru,
Suzuki Tomotaka,
Toyoda Kosuke,
Makita Shinichi,
Fukuhara Suguru,
Munakata Wataru,
Suzuki Tatsuya,
Kobayashi Yukio,
Taniguchi Hirokazu,
Minami Yosuke,
Izutsu Koji,
Tobinai Kensei
Publication year - 2020
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.3501
Subject(s) - medicine , follicular lymphoma , cutoff , diffuse large b cell lymphoma , international prognostic index , rituximab , biopsy , receiver operating characteristic , retrospective cohort study , gastroenterology , lymphoma , nuclear medicine , surgery , physics , quantum mechanics
Abstract Although histologic analysis is the gold standard for diagnosing follicular lymphoma (FL) transformation, many patients are diagnosed with transformation by clinical factors as biopsy specimens often cannot be obtained. Despite the frequency of clinical diagnosis, no clinical assessment tool has yet been established for FL transformation in the rituximab era. We derived and validated a transformation scoring system (TSS) based on retrospective analyses of 126 patients with biopsy‐proven FL and histologic transformation (HT) at two hospitals of the National Cancer Center of Japan. In the derivation set (76 patients), the detailed analyses of the clinical characteristics at disease progression showed that lactate dehydrogenase (LDH) elevation, focal lymph nodal (LN) enlargement, hemoglobin <12 g/dl, and poor performance status (PS) (2‐4) were associated with HT. The weights of these variables were decided based on the regression coefficients. Next, we constructed a TSS encompassing the above four factors: LDH, (> upper limit of normal [ULN], ≤ULN ×2) (1 point), (≥ULN ×2) (2 points); focal LN enlargement, (≥3 cm, <7 cm) (1 point), (≥7 cm) (2 points); hemoglobin <12 g/dl (1 point); poor PS (2 points). We identified a high positive predictive value (PPV) (96.4%) and negative predictive value (NPV) (85.4%) for diagnosing HT when a cutoff score of 2 was selected for our TSS. In an external validation set (50 patients), the probability of HT was high with scores ≥2 (PPV, 93.3%; NPV, 82.9%). We developed a TSS that offers a simple, yet, valuable tool, for diagnosing HT, especially in patients who cannot undergo biopsy.