Evaluation of two prognostic indices for adult T‐cell leukemia/lymphoma in the subtropical endemic area,Okinawa, Japan |
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| Authors: | Keita Tamaki Satoko Morishima Shogo Nomura Yukiko Nishi Sawako Nakachi Sakiko Kitamura Sachie Uchibori Shouhei Tomori Taeko Hanashiro Natsuki Shimabukuro Iori Tedokon Kazuho Morichika Naoya Taira Takeaki Tomoyose Takashi Miyagi Kaori Karimata Masayo Ohama Atsushi Yamanoha Kazumitsu Tamaki Masaki Hayashi Jun‐nosuke Uchihara Kazuiku Ohshiro Yoshitaka Asakura Megumi Kuba‐Miyara Kennosuke Karube Takuya Fukushima Hiroaki Masuzaki |
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| Affiliation: | 1. Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, Second Department of Internal Medicine, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan;2. Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan;3. Department of Hematology, Heartlife Hospital, Nakagusuku, Japan;4. Department of Hematology, Okinawa Prefectural Chubu Hospital, Uruma, Japan;5. Department of Hematology, Nakagami Hospital, Okinawa, Japan;6. Department of Hematology, Naha City Hospital, Naha, Japan;7. Department of Hematology, Okinawa Prefectural Nambu Medical Center and Children's Medical Center, Haebaru, Japan;8. Department of Hematology, Okinawa Red Cross Hospital, Naha, Japan;9. Laboratory of Hematoimmunology, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Nishihara, Japan;10. Departments of Pathology and Cell Biology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan |
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| Abstract: | Aggressive adult T‐cell leukemia/lymphoma (ATL) has an extremely poor prognosis and is hyperendemic in Okinawa, Japan. This study evaluated two prognostic indices (PIs) for aggressive ATL, the ATL‐PI and Japan Clinical Oncology Group (JCOG)‐PI, in a cohort from Okinawa. The PIs were originally developed using two different Japanese cohorts that included few patients from Okinawa. The endpoint was overall survival (OS). Multivariable Cox regression analyses in the cohort of 433 patients revealed that all seven factors for calculating each PI were statistically significant prognostic predictors. Three‐year OS rates for ATL‐PI were 35.9% (low‐risk, n = 66), 10.4% (intermediate‐risk, n = 256), and 1.6% (high‐risk, n = 111), and those for JCOG‐PI were 22.4% (moderate‐risk, n = 176) and 5.3% (high‐risk, n = 257). The JCOG‐PI moderate‐risk group included both the ATL‐PI low‐ and intermediate‐risk groups. ATL‐PI more clearly identified the low‐risk patient subgroup than JCOG‐PI. To evaluate the external validity of the two PIs, we also assessed prognostic discriminability among 159 patients who loosely met the eligibility criteria of a previous clinical trial. Three‐year OS rates for ATL‐PI were 34.5% (low‐risk, n = 42), 9.2% (intermediate‐risk, n = 109), and 12.5% (high‐risk, n = 8). Those for JCOG‐PI were 22.4% (moderate‐risk, n = 95) and 7.6% (high‐risk, n = 64). The low‐risk ATL‐PI group had a better prognosis than the JCOG‐PI moderate‐risk group, suggesting that ATL‐PI would be more useful than JCOG‐PI for establishing and examining novel treatment strategies for ATL patients with a better prognosis. In addition, strongyloidiasis, previously suggested to be associated with ATL‐related deaths in Okinawa, was not a prognostic factor in this study. |
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| Keywords: | adult T‐cell leukemia/lymphoma ATL‐PI JCOG‐PI Okinawa strongyloidiasis |
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