Derivation and Validation of a Novel Lipid Metabolism Level-Based Prognostic Scoring System, Enbc Score, for Newly Diagnosed Mature T and NK Cell Lymphoma

Introduction:The current prognostic scoring systems for mature T and NK cell lymphomas are still insufficient in predicting the outcomes of patients. It is urgently needed to identify novel predictors and develop a more accurate risk stratification system. Lipid metabolism accounts for a significant proportion in the tumor energy metabolism and even occupies a dominant position in non-glycolysis-dependent tumors. Dyslipidemia has been confirmed to be related to inferior outcomes of patients with solid tumors and several hematological malignancies. Nevertheless, there has been none prognostic scoring system containing lipid metabolism-related indicator reported at present. Thus, we aimed to investigate the association between lipid metabolism level and clinical outcomes, and further develop a novel lipid-based prognostic model in patients with newly-diagnosed mature T and NK cell lymphomas. Methods:The study was performed retrospectively in Shandong Provincial Hospital. The patients were divided to the training cohort (from January 2006 to December 2016) and the prospective validation cohort (from January 2017 to June 2020). The inclusion criteria contain: (1) pathologically confirmed; (2) newly diagnosed; (3) with complete clinical and follow-up data; (4) without previous malignancies. The basic data comparison of the two cohorts was performed by Studentttest or Mann-Whitney U test for continuous variables and the chi-square test or Fisher's exact test for categorical data. Univariate analysis and multivariate Cox regression analysis were performed to detect independent predictors and generate a novel prognostic staging system. The efficiency and accuracy of the new scoring system were assessed in two cohorts from different aspects, including time-dependent receiver operating characteristic curves, Brier score and decision curve analysis. Results:We developed EnBC score from a retrospective 115-patient training cohort using a multivariate Cox regression model and tested it in a prospective 58-patient validation cohort. The score was calculated by the extranodal involved sites, β2-microglobulin and serum total cholesterol (Table 1). EnBC score divided patients into four risk grades, low risk (0 point), low-intermediate risk (1 point), intermediate-high risk (2 points), high risk (3 points) (Table 2). Kaplan-Meier curves proved that patients in four risk grades presented significantly distinct long-term prognoses (median OS, NA vs. NA vs. 14.0 vs. 4.0 months