The prognostic role of systemic inflammatory markers on HIV-infected patients with non-Hodgkin lymphoma, a multicenter cohort study

Abstract

Background: The systemic inflammatory response has been postulated as having prognostic significance in a wide range of different cancer types. We aimed to assess the prognostic role of inflammatory markers on survival in HIV-infected patients with Non-Hodgkin Lymphoma (NHL), and to compute a prognostic score based on inflammatory biomarkers.

Methods: We evaluated data on HIV patients with NLH diagnosis between 1998 and 2012 in a HIV Italian Cohort. Using Cox proportional regression model, we assessed the prognostic role of Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR), Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), Prognostic Index (PI), and Prognostic Nutritional Index (PNI). We also computed a risk score equation, assigning patients to a derivation and a validation sample. The area under the curve (AUC) was use to evaluate the predictive ability of this score.

Results: 215 non-Hodgkin lymphoma cases (80.0% males) with a mean age of 43.2 years were included. Deaths were observed in 98 (45.6%) patients during a median follow up of 5 years. GPS, mGPS, PI and PNI were independently associated with risk of death. We also computed a mortality risk score which included PNI and occurrence of an AIDS event within six months from NHL diagnosis. The AUCs were 0.69 (95% CI 0.58 to 0.81) and 0.69 (95% CI 0.57 to 0.81) at 3 and 5 years of the follow-up, respectively.

Conclusions: GPS, mGPS, PI and PNI are independent prognostic factors for survival of HIV patients with NHL.

Figure 1

The relationship between the inflammatory-based prognostic scores considered as continuous (PLR (B), NLR (A) and PNI (C)), and the hazard ratio of death (HR). The HRs were computed in Cox regression models with cubic spline term for each prognostic score adjusted for gender, age at diagnosis, intravenous drug use, AIDS defining event, CD4 cell count, cART therapy prescription and HIV-RNA undetectable. The reference value for each spline term is 3 for NLR, 150 for PLR and 45 for PNI.

Figure 2

Cumulative risk of death according to occurrence of AIDS defining event and PNI. The low-risk group included patients without AIDS defining event within six months from NHL diagnosis and with PNI > 45; the intermediate-risk group included patients with AIDS defining event within six months from data of NHL diagnosis or with PNI < 45; and the high-risk group included patient with AIDS defining event within six months from NHL diagnosis and with PNI < 45.