Nutritional and Immune-Inflammatory Scoring System for Predicting Prognosis in Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma

Background

Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin lymphoma, typically associated with poor prognosis. Current prognostic scoring systems, such as the International Prognostic Index (IPI) and the National Comprehensive Cancer Network (NCCN)-IPI, do not account for the impact of patients' nutritional, immune, and inflammatory responses on their prognosis. To develop a prognostic scoring system for DLBCL patients based on easily obtainable or measurable nutritional, immune, and inflammatory indicators to complement and improve the existing NCCN-IPI and IPI systems.

Methods

A retrospective monocentric analysis of 423 patients who were newly diagnosed DLBCL at Chongqing University Cancer Hospital between January 2020 and September 2023. Relevant patient data were collected from the electronic medical record system, including basic patient characteristics and clinical laboratory results. All eligible patients were randomly divided into training set and validation set at a ratio of 7:3. We used the least absolute shrinkage and selection operator (LASSO) Cox regression model to identify nutritional and immune-inflammatory indicators related to patient prognosis. These indicators were then used to develop the prognostic scoring system. Further analysis was conducted to evaluate the clinical characteristics of this prognostic scoring system and compare it with the IPI and NCCN-IPI.

Results

We developed the Nutritional and Immune-Inflammatory Scoring System (NII), which includes Nutritional Risk Screening (NRS2002), Geriatric Nutritional Risk Index (GNRI), Systemic Immune-Inflammation Index (SII), lactic dehydrogenase to albumin ratio (LAR), β2-microglobulin (β2-MG), CD8⁺ T cells, natural killer (NK) cells, and CD3⁺ T cells. A high NII (> 6) effectively identifies high-risk DLBCL patients and serves as an independent prognostic factor beyond other clinical characteristics, IPI, and NCCN-IPI (p < 0.05). DLBCL patients with a high NII (> 6) exhibit significantly adverse clinical features, including advanced age, Ann Arbor stage (III/IV), B symptoms, elevated LDH levels, and higher risk groups according to IPI and NCCN-IPI (p < 0.05). Combining NII with IPI or NCCN-IPI significantly improves the assessment of patient prognosis compared to using IPI or NCCN-IPI alone (p < 0.05).

Conclusion

The Nutritional and Immune-Inflammatory Scoring System (NII) is an effective tool for identifying high-risk DLBCL patients. A high NII (> 6) serves as an independent prognostic factor, revealing significantly adverse clinical features that are not captured by IPI and NCCN-IPI alone. Combining NII with IPI or NCCN-IPI significantly improves the accuracy of patient prognosis assessments compared to using IPI or NCCN-IPI alone.

No relevant conflicts of interest to declare.