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Objective <p>Extranodal diffuse large B-cell lymphoma (DLBCL) of the oral cavity and maxillofacial region (OC-MR) is rare compared to Waldeyer’s ring (WR) DLBCL, characterized by marked aggressiveness and prognostic heterogeneity. This study aims to develop a special risk stratification model for extranodal DLBCL in OC-MR to overcome the limitations of the conventional International Prognostic Index (IPI) to improve outcome prediction in this high-risk population.</p> Method <p>We conducted a retrospective analysis of 76&#xa0;OC-MR DLBCL patients (43 extranodal and 33 WR-DLBCL) diagnosed between January 2015 and March 2022. Survival outcomes were assessed using Kaplan-Meier methodology with log-rank testing. Prognostic factors were identified through Cox regression and LASSO analysis, with model validation via concordance index (C-index).</p> Result <p>Patients with extranodal OC-MR DLBCL demonstrated significantly greater multisite involvement (<i>p</i> &lt; 0.001) and worse clinical outcomes compared to WR-DLBCL, including shorter median overall survival (17 vs. 26 months, <i>p</i> = 0.0329), shorter progression free survival (13 vs. 25 months, <i>p</i> = 0.0136) and lower objective response rates (67.4% vs. 84.4%, <i>p</i> = 0.003). Hypoalbuminemia (&lt; 37&#xa0;g/L), elevated C-reactive protein (&gt; 5.83&#xa0;mg/L), and high Ki67 index (&gt; 80%) predicted poor prognosis. These clinicopathological biomarkers were integrated with IPI to develop the novel exploratory KACIPI model, which demonstrated a potentially improved discriminative ability than IPI (C-index 0.768 vs. 0.680, <i>p</i> &lt; 0.001) and effectively stratified extranodal OC-MR DLBCL risk groups (<i>p</i> &lt; 0.05).</p> Conclusion <p>Extranodal OC-MR DLBCL exhibits distinct clinicopathological features and inferior survival outcomes. The exploratory KACIPI model may provide improved risk prediction for extranodal OC-MR DLBCL by incorporating tumor proliferation, inflammatory markers, nutritional status into conventional IPI score, enabling more accurate identification of high-risk patients.</p>

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A site-specific risk stratification model for extranodal diffuse large B-cell lymphoma in the oral cavity and maxillofacial region

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月29日

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  • Yuyang Pang,
  • Yehua Yu,
  • Zhaoli Zhang,
  • Wei Lu,
  • Jun Shi

摘要

Objective

Extranodal diffuse large B-cell lymphoma (DLBCL) of the oral cavity and maxillofacial region (OC-MR) is rare compared to Waldeyer’s ring (WR) DLBCL, characterized by marked aggressiveness and prognostic heterogeneity. This study aims to develop a special risk stratification model for extranodal DLBCL in OC-MR to overcome the limitations of the conventional International Prognostic Index (IPI) to improve outcome prediction in this high-risk population.

Method

We conducted a retrospective analysis of 76 OC-MR DLBCL patients (43 extranodal and 33 WR-DLBCL) diagnosed between January 2015 and March 2022. Survival outcomes were assessed using Kaplan-Meier methodology with log-rank testing. Prognostic factors were identified through Cox regression and LASSO analysis, with model validation via concordance index (C-index).

Result

Patients with extranodal OC-MR DLBCL demonstrated significantly greater multisite involvement (p < 0.001) and worse clinical outcomes compared to WR-DLBCL, including shorter median overall survival (17 vs. 26 months, p = 0.0329), shorter progression free survival (13 vs. 25 months, p = 0.0136) and lower objective response rates (67.4% vs. 84.4%, p = 0.003). Hypoalbuminemia (< 37 g/L), elevated C-reactive protein (> 5.83 mg/L), and high Ki67 index (> 80%) predicted poor prognosis. These clinicopathological biomarkers were integrated with IPI to develop the novel exploratory KACIPI model, which demonstrated a potentially improved discriminative ability than IPI (C-index 0.768 vs. 0.680, p < 0.001) and effectively stratified extranodal OC-MR DLBCL risk groups (p < 0.05).

Conclusion

Extranodal OC-MR DLBCL exhibits distinct clinicopathological features and inferior survival outcomes. The exploratory KACIPI model may provide improved risk prediction for extranodal OC-MR DLBCL by incorporating tumor proliferation, inflammatory markers, nutritional status into conventional IPI score, enabling more accurate identification of high-risk patients.