title: Multicentre validation of a prognostic index for overall survival in chronic lymphocytic leukaemia.
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, β-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, β-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.
authors.affiliation: Clinical and Experimental Onco-Hematology Unit, IRCCS, Centro di Riferimento Oncologico, Aviano (PN), Italy. pbulian@cro.it
authors.forename: Pietro
authors.initials: P
authors.lastname: Bulian
authors.forename: Michela
authors.initials: M
authors.lastname: Tarnani
authors.forename: Davide
authors.initials: D
authors.lastname: Rossi
authors.forename: Francesco
authors.initials: F
authors.lastname: Forconi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Del Poeta
authors.forename: Francesco
authors.initials: F
authors.lastname: Bertoni
authors.forename: Emanuele
authors.initials: E
authors.lastname: Zucca
authors.forename: Marco
authors.initials: M
authors.lastname: Montillo
authors.forename: Gabriele
authors.initials: G
authors.lastname: Pozzato
authors.forename: Silvia
authors.initials: S
authors.lastname: Deaglio
authors.forename: Giovanni
authors.initials: G
authors.lastname: D'Arena
authors.forename: Dimitar
authors.initials: D
authors.lastname: Efremov
authors.forename: Roberto
authors.initials: R
authors.lastname: Marasca
authors.forename: Francesco
authors.initials: F
authors.lastname: Lauria
authors.forename: Valter
authors.initials: V
authors.lastname: Gattei
authors.forename: Gianluca
authors.initials: G
authors.lastname: Gaidano
authors.forename: Luca
authors.initials: L
authors.lastname: Laurenti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D049451:Nomograms; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents