Prognostic indexes

Lymphocytopenia [count less than 600 mm3 (0.6 x 109/L) or less than 8% (0.08) of white blood cell count or both] International Prognostic Index—Diffuse, Aggressive Non-Hodgkin s Lymphoma... 

Prognosis depends on histologic subtype and clinical risk factors (e.g., age more than 60 years, performance status of 2 or more, elevated lactic dehydrogenase, extranodal involvement, and stage III or IV disease). These risk factors are used to calculate the International Prognostic Index. 

A newer prognostic index uses similar risk factors except that poor performance status is replaced with low hemoglobin (less than 12 g/dL). Current research is focused on the prognostic importance of phenotypic and molecular characteristics of NHL. 

Diffuse large B-cell lymphomas are the most common lymphoma in patients of all ages but most commonly seen in the seventh decade. Extranodal disease is present at diagnosis in 30% to 40% of patients. The International Prognostic Index score correlates with prognosis. Diffuse aggressive lymphomas are sensitive to chemotherapy with cure achieved in some patients. 

Aydin F, Yilmaz M, Ozdemir F et al. Correlation of serum lL-2, lL-6 and IL-10levels with International Prognostic Index in patients with aggressive non-Hodgkin s lymphoma. Am J Clin Oncol 2002 25 570-572. 

B5. Barrans, S. L., Carter, I., Owen, R. G., Davies, F. E., Patmore, R. D., Haynes, A. P., Morgan, G. L, and Jack, A. S., Germinal center phenotype and bcl-2 expression combined with the International Prognostic Index improves patient risk stratification in diffuse large B-cell lymphoma. Blood 99,1136-1143 (2002). 

A prognostic model is the mathematical combination of two or more patient or disease characteristics to predict outcome. Confusingly, prognostic models are also termed prognostic indexes, risk scores, probability models, risk stratification schemes or clinical prediction rules (Reilly and Evans 2006). To be useful, they must be shown to predict clinically relevant outcomes reliably. They must, therefore, be derived from a representative cohort in which outcome has been measured accurately. Next, they must be validated, not just in the data from which they were derived (internal validation) but also on data from independent cohorts (external validation) (Wyatt and Altman 1995 Justice et al. 1999 Altman and Royston 2000). Lastly, a model must be simple to use and have clinical credibility, otherwise it is unlikely to be taken up in routine clinical practice (Table 14.1). 

Finned, G., Bellon, S., Merkel, C., Mormino, P, Tirelli, M., Gatta, A., Zuin, R. Evaluation of splanchnic angiography as a prognostic index of survival in patients with cirrhosis. Scand. J. Gastroenterol. 1991 26 951-960... 

Politou M, Meletis J, et al. Soluble receptor activator of nuclear factor kB ligand-osteoprotegerin ratio predicts survival in multiple myeloma proposal for a novel prognostic index. Blood 2003 102 1064-9. 

IPI, International Prognostic Index MALT, mucosa-associated lymphoid tissue. 

TABLE 1 29—1 0. Risk Factors and Survival According to the Follicular Lymphoma International Prognostic Index (FLIPI)... 

FLIPI Folhcular Lymphoma International Prognostic Index... 

Solal-CeUgny P, Roy P, Colombat P, et al. Follicular lymphoma international prognostic index. Blood 2004 104 1258-1265. 

Haybittle JL, Hayhoe EG, Eastetling MJ, et al. Review of Btitish National Lymphoma Investigation studies of Hodgkin s disease and development of prognostic index. Lancet. 1985 1 967-972. 

Abdominal ultrasound (US), thanks to its accuracy, good repeatability and non-invasiveness is currently employed in many chronic inflammatory conditions, not only for purely diagnostic purposes, but also for management of the disease. In Crohn s disease (CD) patients, US has become the first-line imaging procedure for early diagnosis of the disease (Parente et al. 2004a), and more frequently for the follow-up, to detect intra-abdominal complications (strictures, fistulae and abscesses), to assess activity and monitor the course of disease, as a prognostic index of recurrence (Table 7.1). 

Llad6 L, Virgin J, Figueras J et al (2000) A prognostic index of the survival of patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization. Cancer 88 50-57... 

Leung TW, Tang AM, Zee B, et al (2002) Construction of the Chinese University Prognostic Index for hepatocellular carcinoma and comparison with the TNM staging system, the Okuda staging system, and the Cancer of the Liver Italian Program staging system a study based on 926 patients. Cancer 94 1760-1769... 

Rosenthal P. and M. Haight, 1990. Aminotransferase as a prognostic index in infants with liver disease. Clin. Chem. 36, 346-348. 

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