APPLICATION OF THE INTERNATIONAL-PROGNOSTIC-INDEX IN A STUDY OF CHINESE PATIENTS WITH NON-HODGKINS-LYMPHOMA AND A HIGH-INCIDENCE OF PRIMARYEXTRANODAL LYMPHOMA

BACKGROUND. Chemotherapy containing anthracycline is the standard init ial treatment for aggressive non-Hodgkin's lymphoma (NHL), and the int ernational Prognostic Index (IPI) is widely accepted as the standard t ool for determining the prognosis of patients with this disease. Howev er, the data on which the IPI was based primarily came from studies co nducted in Western countries. It may not be directly applicable to Asi an populations, in which the incidence of primary extranodal lymphoma (PENL) is known to be high. METHODS. The authors conducted a retrospec tive study of 218 patients with aggressive NHL who were treated with c hemotherapy. They analyzed the distribution of stage and pathology, pr ognostic factors, toxicity, and treatment outcome. The IPI was then ap plied and its ability to identify distinct prognostic groups tested. R ESULTS. Eighty-six patients (39.4%) had lymph node lymphoma (LNL) and 132 (60.6%) had primary extranodal lymphoma (defined as non-Hodgkin's lymphoma with primary presentation, bulk of disease, and histologic co nfirmation at an extranodal site). The most common primary extranodal sites were the stomach (22%) and Waldeyer's tonsillar ring (18.9%). Th e complete response rate of PENL patients to chemotherapy containing a nthracycline was 52%, as compared with 64% of the LNL group. The 5-yea r survival rates for patients with LNL and PENL were 57.4% and 52.1%, respectively. The toxicity in the two patient groups was similar. Four of the prognostic factors in the IPI-age, serum LDH, performance stat us, and disease stage-predicted significantly different survival for P ENL and LNL patients. However, the number of extranodal sites involved was not a significant predictive variable in PENL. CONCLUSIONS. The I PI was applicable to this Chinese population in which the incidence of PENL was high, although the number of extranodal sites did not achiev e statistical significance as a risk factor. A proposal for modificati on was made. Chemotherapy containing anthracycline was an effective tr eatment for both PENL and LNL patients. (C) 1998 American Cancer Socie ty.