四种预后评分系统在早期无症状慢性淋巴细胞白血病患者中评估价值比较

OBJECTIVE: To compare the prognostic value of four prognostic models in predicting time to first treatment（TTFT）in patients with Binet A Chinese chronic lymphocytic leukemia（CLL）. METHODS: This retrospective analysis included one hundred and ten patients with Binet A CLL, initially diagnosed in the First Affiliated Hospital of Nanjing Medical University（Pukou CLL center）from June 2009 to January 2020. Risk stratification was conducted according to IPS-E, CLL-IPI, CLL1-PM, and Barcelona-Brno prognostic models. RESULTS: Among 110 patients with Binet A CLL patients, the median age was 58（25–84）years. The median follow-up time was 35（4–189）months, and 57（51.8％）patients met the indication for treatment due to symptomatic disease progression during follow-up. Log-rank analysis of nine variables was conducted involving age, Rai stage, absolute lymphocyte count（ALC）, lymph node size, lymphocyte doubling time（LDT）, β(2)-Microglobulin, IGHV status, TP53, and Del（11q）. Additionally, Rai Ⅰ–Ⅲ, ALC>15×10(9)/L, palpable lymph node size ≥1cm, β(2)-Microglobulin >3.5 mg/L, unmutated IGHV, TP53 mutation or deletion, and 11q deletion were independent risk factors of TTFT. Predictive value of each model was assessed by Harrel C-index and Akaike information criterion（AIC）with CLL1-PM（C-index＝0.736, AIC＝777）, followed by CLL-IPI（C-index＝0.722, AIC＝933）, IPS-E（C-index＝0.683, AIC＝1004）, and Barcelona-Brno prognostic model （C-index＝0.663, AIC＝986）. CONCLUSION: All four prognostic models effectively predicted TTFT. IPS-E might be an ideal model to guide clinical surveillance because of its easy accessibility and low expenses in routine clinical practice. Therefore, for patients receiving fluorescence in situ hybridization（FISH）and next-generation sequencing（NGS）examination at diagnosis, CLL-IPI or CLL1-PM could be applied to evaluate their prognosis more comprehensively.