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Prognostic utility of a geriatric nutritional risk index in combination with a comorbidity index in elderly patients with diffuse large B cell lymphoma
Author(s) -
Lee Shin,
Fujita Kei,
Morishita Tetsuji,
Negoro Eiju,
Oiwa Kana,
Tsukasaki Hikaru,
Yamamura Osamu,
Ueda Takanori,
Yamauchi Takahiro
Publication year - 2021
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.16743
Subject(s) - medicine , diffuse large b cell lymphoma , proportional hazards model , multivariate analysis , multivariate statistics , oncology , comorbidity , charlson comorbidity index , hazard ratio , international prognostic index , retrospective cohort study , lymphoma , receiver operating characteristic , statistics , confidence interval , mathematics
Reflecting the increasing risk in elderly patients with diffuse large B cell lymphoma (DLBCL), prognostic predictors other than the International Prognostic Index have attracted more attention. This study presents the first analysis of the prognostic utility of the Geriatric Nutritional Risk Index (GNRI) in combination with the Charlson Comorbidity Index (CCI) for overall survival (OS) in elderly DLBCL patients. A multicentre retrospective was conducted on a cohort of 451 patients (≥65 years). The GNRI and CCI were independent predictors in a multivariate Cox proportional hazard model. There was a nonlinear correlation between the GNRI and OS in a Cox model with restricted cubic spline. Multivariate receiver operating characteristic curves showed a significant improvement in prediction accuracy when the GNRI was added to CCI. Adding the GNRI to CCI yielded a significant category‐free net reclassification improvement (0·556; 95% CI: 0·378–0·736, P < 0·001) and integrated discrimination improvement (0·094; 95% CI: 0·067–0·122, P < 0·001). The decision curve analysis demonstrated the clinical net benefit associated with the adoption of the GNRI. The GNRI was not only a predictor of OS but also remarkably improved the prognosis prediction accuracy when incorporated with the CCI, having the ability to stratify the prognosis of elderly DLBCL patients.