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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2022.015    [Accepted]
A New Prognostic index for Extranodal Natural killer/T cell Lymphoma: Incorporation of Serum β-2 Microglobulin to PINK
Sora Kang1 , Hyungwoo Cho1, Shin Kim1, Kyoungmin Lee1, Eun Hee Kang1, Jung Sun Park1, Yoon Sei Lee2, Chan-Sik Park3, Heounjeong Go3, Jooryung Huh3, Jin Sook Ryu4, Sang-Wook Lee5, Seok Jin Kim6, Won Seog Kim6, Sang Eun Yoon6, Young Hyeh Ko7, Cheolwon Suh1
1Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
3Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
4Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
5Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
6Division of Hematology and Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
7Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence  Cheolwon Suh ,Tel: 82-2-3010-3209, Fax: 82-2-3010-6961, Email: csuh@amc.seoul.kr
Received: January 8, 2022;  Accepted: March 30, 2022.  Published online: March 31, 2022.
*Sora Kang and Hyungwoo Cho contributed equally to this work.
ABSTRACT
Purpose
Prognostic Index for Natural Killer Lymphoma (PINK) is the most widely accepted prognostic model for patients with Extranodal natural killer/T-cell lymphoma (ENKTL) treated with non-anthracycline based therapy. We aimed to evaluate the prognostic implications of serum β-2 microglobulin (β2M) in the context of PINK and proposed a new prognostic model.
Materials and Methods
A total of 138 patients who were newly diagnosed with ENKTL and treated with non-anthracycline-based chemotherapy were identified. The cut-off value of high serum β2M was calculated by maximal-chi square methods (4.1 mg/L). A new prognostic model incorporating serum β2M into PINK was proposed and validated in an independent validation cohort (n=88).
Results
The patients’ median age was 53.5 years (range, 19-80). Patients with high serum β2M levels had significantly worse overall survival (OS) and progression-free survival (PFS). In multivariate analysis, high serum β2M was an independent adverse prognostic factor for OS. A new PINK-B model stratified patients into three groups with distinct OS and PFS in the training cohort (3-year OS, 84.1% [95% CI 75.1-94.2], 46.8% [36.1-60.8] and 17.6% [6.32-49.2] for the low-, intermediate, and high-risk groups, respectively; 3-year PFS, 70.6% [59.4-83.8], 35.9% [25.9-49.8], and 7.35% [1.16-46.7] for the low-, intermediate, and high-risk groups, respectively). The PINK-B model was further validated in an independent cohort.
Conclusion
Serum β2M is an independent prognostic factor for ENKTL patients. The new serum β2M-based prognostic model may be useful for identifying ultra-high-risk patients, and it can easily be adopted into daily clinical practice.
Key words: Extranodal natural killer/T-cell lymphoma, β-2 microglobulin, Prognostic index, PINK, PINK-B
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