Extranodal natural killer/T-cell lymphoma (ENKTL) is a rare and aggressive malignancy with poor outcomes in advanced stages. Current prognostic indices fail to fully account for the heterogeneity of stage Ⅲ–Ⅳ ENKTL. We aimed to develop a nomogram integrating inflammatory and clinical parameters to improve prognostic prediction. We retrospectively analyzed 291 patients with stage III/IV ENKTL across eight hospitals for model development and 145 patients for validation. Optimal cut-off values for absolute lymphocyte count (ALC), absolute monocyte count (AMC), and lymphocyte-to-monocyte ratio (LMR) were determined. Cox regression yielded independent prognostic indicators, which were incorporated into a nomogram. The model was validated with the concordance index (C-index), receiver operating characteristic curves, area under the curve (AUC) and calibration analysis. Five factors for overall survival (OS) were identified: age > 60 years (HR: 1.749), AMC > 0.4 × 10⁹/L (HR: 1.423), LMR ≤ 1.47 (HR: 1.460), visceral organ involvement (HR: 1.979), and bone marrow involvement (HR: 1.559). These were integrated into a nomogram with a C-index of 0.644 (95% CI: 0.601–0.687). The nomogram showed better discriminatory ability compared to both the prognostic index of natural killer lymphoma (PINK) (AUC: 0.721 vs. 0.595, P = 0.0085) and nomogramrevised risk index (NRI) (AUC: 0.721 vs. 0.585, P = 0.0034). Patients were stratified into high- and low-risk groups based on median nomogram score, with the low-risk group showing significantly better OS ( High-risk vs. low-risk group, P < 0.0001) and progression-free survival (PFS) (High-risk vs. low-risk group, P < 0.0001). In the validation cohort, the C-index was 0.634 and the 3-year AUC for OS was 0.705. Both OS and PFS were significantly inferior in the high-risk group (OS: P = 0.0015; PFS: P = 0.02). We developed an inflammation-based prognostic nomogram for advanced-stage ENKTL with moderate predictive accuracy potentially aiding clinicians in individualized risk stratification. Prospective multicenter studies are warranted to further optimize and validate its clinical applicability.
Xia et al. (Tue,) studied this question.