Relationship between serum free light chain and selenium levels and clinicopathological characteristics of B-cell non-Hodgkin lymphoma patients and construction of prognostic risk model

doi:10.3969/j.issn.1673-8640.2024.07.012

Abstract

Abstract:

Objective To investigate the relationship between serum free light chain （FLC） and selenium levels in clinicopathological characteristics of B-cell non-Hodgkin lymphoma （B-NHL） patients，and to construct a prognostic risk model. Methods A total of 164 B-NHL patients from Yibin First People's Hospital from June 2014 to June 2021 were enrolled as training set. Another 82 patients with B-NHL were enrolled as validation set. The clinicopathological characteristics of all the patients were collected，and serum FLC and selenium levels and blood routine test were determined and performed. All the patients were followed up for 8 to 108 months until June 2023. Kaplan-Meier survival curve was used to evaluate the survival of patients with different serum FLC and selenium levels. The factors on progress-free survival and overall survival in B-NHL patients were evaluated by Cox proportional hazard regression analysis. R software was used to construct a nomogram risk model for predicting the prognosis of B-NHL patients and evaluating its efficacy. Results B-NHL patients were classified into low FLC level （87 cases） and high FLC level （77 cases） according to whether the FLC level was increased. There was statistical significance in Ann Arbor stage and B symptoms between B-NHL patients with low FLC level and high FLC level （P<0.05）. According to the median of serum selenium level （1.12 μmol/L），all the patients were classified into low selenium level （82 cases） and high selenium level （82 cases），and there was statistical significance in the Eastern Cooperative Oncology Group（ECOG）score between low selenium level and high selenium level B-NHL patients （P<0.05）. The progress-free survival and overall survival of patients with high FLC level and low selenium level were lower than those with low FLC level and high selenium level，respectively （P<0.01）. Multivariate Cox proportional risk regression analysis showed that age>60 years old，international prognostic index （IPI） score of 3-5，lactate dehydrogense（LDH）>250 U·L^-1，beta2-microglobulin （β2-MG）> 3 mg·L^-1 and decreased serum selenium level were risk factors for decreased progress-free survival and overall survival in B-NHL patients （P<0.05）. Increased serum FLC level was a risk factor for decreased progress-free survival in B-NHL patients （P<0.01）. The area under curve of the prognostic risk model was 0.856. The accuracy，sensitivity and specificity were similar in training set and validation set. The prognostic risk model had good stability （Nagelkerke R2=0.602）. Conclusions High FLC level is related to Ann Arbor stage and B symptoms of B-NHL patients，low selenium level is related to ECOG score of B-NHL patients. The nomogram risk model based on clinicopathological characteristics can accurately evaluate the prognosis of B-NHL patients.

Key words: Free light chain, Selenium, B-cell non-Hodgkin lymphoma, Pathological characteristic, Prognosis

CLC Number:

R446.1

TU Jiaqiang, WEN Xiaoling. Relationship between serum free light chain and selenium levels and clinicopathological characteristics of B-cell non-Hodgkin lymphoma patients and construction of prognostic risk model[J]. Laboratory Medicine, 2024, 39(7): 687-695.

Figures/Tables 7

References 23

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项目	例数	FLC		硒		项目	例数	FLC		硒
项目	例数	低水平	高水平	低水平	高水平	项目	例数	低水平	高水平	低水平	高水平
年龄						Hams分型
≤60岁	102	55	47	45	57	GCB型	17	8	9	10	7
>60岁	62	32	30	37	25	non-GCB型	147	79	68	72	75
χ2值		0.083		3.734		χ2值		0.273		0.591
P值		0.774		0.053		P值		0.601		0.442
性别						发病起始部位
男性	85	44	41	44	41	淋巴结内	110	59	51	58	52
女性	79	43	36	38	41	淋巴结外	54	28	26	24	30
χ2值		0.117		0.220		χ2值		0.046		0.994
P值		0.733		0.639		P值		0.830		0.319
Ann Arbor分期						骨髓受累
Ⅰ~Ⅱ期	97	58	39	44	53	否	146	79	67	71	75
Ⅲ~Ⅳ期	67	29	38	38	29	是	18	8	10	11	7
χ2值		4.337		2.044		χ2值		0.601		0.998
P值		0.037		0.153		P值		0.438		0.318
B症状						肝脏受累
无	98	60	38	44	54	否	112	62	50	52	60
有	66	27	39	38	28	是	52	25	27	30	22
χ2值		6.535		2.536		χ2值		0.756		1.802
P值		0.011		0.111		P值		0.385		0.179
IPI评分						结外受累区域数
0~2分	74	44	30	33	41	0	54	34	20	21	33
3~5分	90	43	47	49	41	1个	71	32	39	40	31
χ2值		2.225		1.576		2个	39	21	18	21	18
P值		0.136		0.209		χ2值		3.956		4.038
ECOG评分						P值		0.138		0.133
0~1分	122	68	54	52	70	LDH
2~4分	42	19	23	30	12	≤250 U·L^-1	91	49	42	43	48
χ2值		1.383		10.370		>250 U·L^-1	73	38	35	39	34
P值		0.240		0.001		χ2值		0.052		0.617
β2-MG						P值		0.819		0.432
≤3 mg·L^-1	90	51	39	42	48	血红蛋白
>3 mg·L^-1	74	36	38	40	34	≥126 g·L^-1	83	49	34	37	46
χ2值		1.048		0.886		<126 g·L^-1	81	38	43	45	36
P值		0.306		0.346		χ2值		2.419		1.976
淋巴细胞计数						P值		0.120		0.160
≤2.83×109·L^-1	79	47	32	34	45	白细胞计数
>2.83×109·L^-1	85	40	45	48	37	≤9×109·L^-1	68	42	26	29	39
χ2值		2.542		2.955		>9×109·L^-1	96	45	51	53	43
P值		0.111		0.086		χ2值		3.543		2.512
血小板计数						P值		0.060		0.113
≤100×109·L^-1	31	14	17	19	12
>100×109·L^-1	133	73	60	63	70
χ2值		0.955		1.949
P值		0.329		0.163

项目	例数	FLC		硒		项目	例数	FLC		硒
项目	例数	低水平	高水平	低水平	高水平	项目	例数	低水平	高水平	低水平	高水平
年龄						Hams分型
≤60岁	102	55	47	45	57	GCB型	17	8	9	10	7
>60岁	62	32	30	37	25	non-GCB型	147	79	68	72	75
χ2值		0.083		3.734		χ2值		0.273		0.591
P值		0.774		0.053		P值		0.601		0.442
性别						发病起始部位
男性	85	44	41	44	41	淋巴结内	110	59	51	58	52
女性	79	43	36	38	41	淋巴结外	54	28	26	24	30
χ2值		0.117		0.220		χ2值		0.046		0.994
P值		0.733		0.639		P值		0.830		0.319
Ann Arbor分期						骨髓受累
Ⅰ~Ⅱ期	97	58	39	44	53	否	146	79	67	71	75
Ⅲ~Ⅳ期	67	29	38	38	29	是	18	8	10	11	7
χ2值		4.337		2.044		χ2值		0.601		0.998
P值		0.037		0.153		P值		0.438		0.318
B症状						肝脏受累
无	98	60	38	44	54	否	112	62	50	52	60
有	66	27	39	38	28	是	52	25	27	30	22
χ2值		6.535		2.536		χ2值		0.756		1.802
P值		0.011		0.111		P值		0.385		0.179
IPI评分						结外受累区域数
0~2分	74	44	30	33	41	0	54	34	20	21	33
3~5分	90	43	47	49	41	1个	71	32	39	40	31
χ2值		2.225		1.576		2个	39	21	18	21	18
P值		0.136		0.209		χ2值		3.956		4.038
ECOG评分						P值		0.138		0.133
0~1分	122	68	54	52	70	LDH
2~4分	42	19	23	30	12	≤250 U·L^-1	91	49	42	43	48
χ2值		1.383		10.370		>250 U·L^-1	73	38	35	39	34
P值		0.240		0.001		χ2值		0.052		0.617
β2-MG						P值		0.819		0.432
≤3 mg·L^-1	90	51	39	42	48	血红蛋白
>3 mg·L^-1	74	36	38	40	34	≥126 g·L^-1	83	49	34	37	46
χ2值		1.048		0.886		<126 g·L^-1	81	38	43	45	36
P值		0.306		0.346		χ2值		2.419		1.976
淋巴细胞计数						P值		0.120		0.160
≤2.83×109·L^-1	79	47	32	34	45	白细胞计数
>2.83×109·L^-1	85	40	45	48	37	≤9×109·L^-1	68	42	26	29	39
χ2值		2.542		2.955		>9×109·L^-1	96	45	51	53	43
P值		0.111		0.086		χ2值		3.543		2.512
血小板计数						P值		0.060		0.113
≤100×109·L^-1	31	14	17	19	12
>100×109·L^-1	133	73	60	63	70
χ2值		0.955		1.949
P值		0.329		0.163

项目	无进展生存率		总生存率
项目	HR^①值（95%CI^②）	P值	HR^①值（95%CI^②）	P值
性别	1.033（0.541~1.588）	0.162	1.019（0.391~1.719）	0.177
年龄	2.431（1.806~2.917）	0.029	2.064（1.708~2.403）	0.034
Ann Arbor分期	1.396（0.902~1.865）	0.068	1.325（0.842~1.826）	0.073
B症状	1.062（0.608~1.495）	0.147	1.047（0.401~1.642）	0.159
骨髓受累	1.302（0.899~1.714）	0.084	1.291（0.608~1.917）	0.090
肝脏受累	1.284（0.639~1.908）	0.102	1.225（0.505~1.714）	0.113
结外受累区域数	1.206（0.713~1.710）	0.121	1.183（0.219~2.062）	0.136
IPI评分	3.649（3.245~4.082）	0.007	3.475（1.911~3.896）	0.009
ECOG评分	1.564（0.418~2.612）	0.058	1.439（0.711~2.109）	0.060
LDH	4.872（4.255~5.431）	<0.001	4.163（3.508~4.742）	0.002
β₂-MG	3.215（2.709~3.728）	0.011	2.718（2.259~3.170）	0.017
FLC	4.537（4.090~5.002）	<0.001	1.873（1.319~2.347）	0.042
硒	2.913（2.639~3.264）	0.015	2.402（2.005~2.814）	0.031

项目	无进展生存率		总生存率
项目	HR^①值（95%CI^②）	P值	HR^①值（95%CI^②）	P值
性别	1.033（0.541~1.588）	0.162	1.019（0.391~1.719）	0.177
年龄	2.431（1.806~2.917）	0.029	2.064（1.708~2.403）	0.034
Ann Arbor分期	1.396（0.902~1.865）	0.068	1.325（0.842~1.826）	0.073
B症状	1.062（0.608~1.495）	0.147	1.047（0.401~1.642）	0.159
骨髓受累	1.302（0.899~1.714）	0.084	1.291（0.608~1.917）	0.090
肝脏受累	1.284（0.639~1.908）	0.102	1.225（0.505~1.714）	0.113
结外受累区域数	1.206（0.713~1.710）	0.121	1.183（0.219~2.062）	0.136
IPI评分	3.649（3.245~4.082）	0.007	3.475（1.911~3.896）	0.009
ECOG评分	1.564（0.418~2.612）	0.058	1.439（0.711~2.109）	0.060
LDH	4.872（4.255~5.431）	<0.001	4.163（3.508~4.742）	0.002
β₂-MG	3.215（2.709~3.728）	0.011	2.718（2.259~3.170）	0.017
FLC	4.537（4.090~5.002）	<0.001	1.873（1.319~2.347）	0.042
硒	2.913（2.639~3.264）	0.015	2.402（2.005~2.814）	0.031

项目	无进展生存率		总生存率
项目	HR值（95%CI）	P值	HR值（95%CI）	P值
年龄>60岁	1.928（1.406~2.437）	0.041	1.642（1.216~2.085）	0.045
IPI评分为3~5分	3.292（2.856~3.675）	0.010	2.953（2.371~3.516）	0.014
LDH>250 U·L^-1	4.372（3.859~4.907）	0.001	3.954（3.602~4.285）	0.003
β₂-MG>3 mg·L^-1	2.823（2.407~3.281）	0.015	2.439（1.902~2.899）	0.028
FLC升高	3.873（3.418~4.312）	0.005	1.402（0.875~2.118）	0.064
硒降低	2.503（2.072~3.068）	0.026	2.069（1.433~2.615）	0.033