Cancer Res Treat.  2023 Jan;55(1):314-324. 10.4143/crt.2022.015.

A New Prognostic Index for Extranodal Natural Killer/T-Cell Lymphoma:Incorporation of Serum β-2 Microglobulin to PINK

• Kang S
• Cho H
• Kim S
• Lee K
• Kang EH
• Park JS
• Lee YS
• Park CS
• Go H
• Huh J
• Ryu JS
• Lee SW
• Kim SJ
• Kim WS
• Yoon SE
• Ko YH
• Suh C

• KMID: 2538014
• DOI: http://doi.org/10.4143/crt.2022.015

Abstract

Purpose
Prognostic Index for Natural Killer Lymphoma (PINK) is the most widely accepted prognostic model for patients withextranodal 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 to 80 years). 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 (Prognostic Index for Natural Killer Lymphoma-serum β-2 microglobulin) model stratifiedpatients into three groups with distinct OS and PFS in the training cohort (3-year OS, 84.1% [95% confidence interval, 75.1 to 94.2], 46.8% [36.1 to 60.8] and 17.6% [6.3 to 49.2] for the low-, intermediate, and high-risk groups, respectively; 3-year PFS, 70.6% [59.4 to 83.8], 35.9% [25.9 to 49.8], and 7.35% [1.1 to 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.

Keyword

Extranodal natural killer/T-cell lymphoma; β-2 microglobulin; Prognostic index; PINK; PINK-B

Figure

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  Fig. 1 Overall survival (A) and progression-free survival (B) for all patients. Overall survival (C) and progression-free survival (D) according to serum β-2 microglobulin (β2M) 4.1 mg/L.

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  Fig. 2 Overall survival (A) and progression-free survival (B) according to Prognostic Index for Natural Killer Lymphoma.

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  Fig. 3 Prognostic value of serum β2M in the risk groups determined by PINK. Overall survival according to serum β2M levels (< 4.1 mg/L vs. ≥ 4.1 mg/L) in the PINK low-risk group (A), PINK intermediate group (B), and PINK high-risk group (C). β2M, β-2 microglobulin; PINK, Prognostic Index for Natural Killer Lymphoma.

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  Fig. 4 (A) Overall survival of patients according to PINK and incorporating serum β2M for the PINK high-risk groups. Overall survival (B) and progression-free survival (C) according to PINK-B. β2M, β-2 microglobulin; PINK, Prognostic Index for Natural Killer Lymphoma; PINK-B, Prognostic Index for Natural Killer Lymphoma–serum β-2 microglobulin.

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  Fig. 5 Overall survival (A) and progression-free survival (B) according to PINK-B in the validation cohort. PINK-B, Prognostic Index for Natural Killer Lymphoma–serum β-2 microglobulin.

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