DLBCL预后计算器——IPI评分与生存预测

计算弥漫性大B细胞淋巴瘤的国际预后指数（IPI），评估风险组别和5年总生存率，为治疗规划提供参考。

输入患者的临床和实验室参数，计算DLBCL的IPI及R-IPI评分和相应的生存率估计。

DLBCL预后计算器——IPI评分与生存预测
计算弥漫性大B细胞淋巴瘤的国际预后指数（IPI），评估风险组别和5年总生存率，为治疗规划提供参考。

关于DLBCL预后计算器

Diffuse Large B-Cell Lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma, accounting for approximately 30–35% of all newly diagnosed lymphoma cases worldwide. It is an aggressive B-cell malignancy characterised by rapidly enlarging lymph nodes, frequent extranodal involvement, and constitutional B symptoms. Despite its aggressive nature, DLBCL is potentially curable in a substantial proportion of patients, making accurate initial risk stratification critically important for treatment planning. The International Prognostic Index (IPI) was developed in 1993 by a large international collaborative group and published in the New England Journal of Medicine. The study identified five clinical and laboratory variables — patient age, ECOG performance status, serum lactate dehydrogenase (LDH) level, number of extranodal sites, and Ann Arbor clinical stage — each of which independently predicted overall survival. By assigning one point for each adverse factor present, the IPI creates a 0–5 point score that stratifies patients into four risk groups with dramatically different 5-year overall survival rates in the original anthracycline-based chemotherapy era. The Low risk group (IPI 0–1) had an estimated 5-year overall survival of approximately 73% with historical CHOP-based chemotherapy, rising to over 80% with the addition of rituximab in the R-CHOP era. The Low-Intermediate group (IPI 2) achieved approximately 51% 5-year survival historically, the High-Intermediate group (IPI 3) approximately 43%, and the High risk group (IPI 4–5) approximately 26%. With modern R-CHOP, these figures have improved across all categories, and with salvage CAR-T therapy for relapsed/refractory disease, a further subset of high-risk patients can achieve durable remissions. The Revised IPI (R-IPI), published in 2007 using rituximab-era data, identified three prognostic groups. The Very Good group (R-IPI 0) achieves approximately 94% 4-year overall survival; the Good group (R-IPI 1–2) approximately 79%; and the Poor group (R-IPI 3–5) approximately 55%. The R-IPI better captures the improved outcomes associated with immunochemotherapy and is increasingly used alongside the original IPI in clinical practice. Beyond the classic IPI factors, cell of origin biology substantially modifies prognosis. The germinal centre B-cell (GCB) subtype, identified by immunohistochemistry (Hans algorithm) or gene expression profiling, has a more favourable prognosis than the activated B-cell (ABC) subtype, which exhibits constitutive NF-κB activation and poorer response to R-CHOP. Additionally, double-hit lymphoma — defined by concurrent MYC and BCL2 or BCL6 translocations — has a substantially worse prognosis than the IPI score alone predicts, typically warranting consideration of intensified induction regimens. This calculator integrates the IPI and R-IPI scoring algorithms with supplementary prognostic indicators to provide a comprehensive initial risk assessment. The tool is intended as a clinical decision support resource for oncologists, haematologists, and advanced practitioners managing DLBCL, and all management decisions should be made in the context of multidisciplinary team discussion and in accordance with current treatment guidelines.

IPI计算器示例

展示从低危到双打击淋巴瘤情形的四个临床概况。

临床概况IPI评分/风险关键预后特征
Age 45, ECOG 0, Stage I, 0 extranodal sites, Normal LDH, No bulky disease, GCB, Neg double-hitIPI 0 — Low RiskNo IPI risk factors. Estimated 5-year OS ~73%. Favourable GCB cell of origin.
Age 68, ECOG 1, Stage III, 1 extranodal site, Elevated LDH, No bulky disease, ABC, Neg double-hitIPI 3 — High-IntermediateAge > 60, elevated LDH, and stage III contribute. ABC cell of origin unfavourable.
Age 72, ECOG 2, Stage IV, 2 extranodal sites, Elevated LDH, Bulky disease, ABC, Neg double-hitIPI 5 — High RiskAll five IPI factors present. Estimated 5-year OS ~26%. Requires aggressive management.
Age 58, ECOG 1, Stage IV, 3 extranodal sites, Elevated LDH, Bulky disease, Unclassified, Pos double-hitIPI 3 — High-Intermediate + Double HitDouble hit status confers additional poor prognosis beyond IPI score.

如何使用DLBCL预后计算器

  1. Enter the patient's age in years and select the ECOG performance status (0 = fully active; 4 = completely disabled).
  2. Select the Ann Arbor staging result from the baseline PET/CT or contrast CT and bone marrow biopsy.
  3. Enter the number of extranodal sites of involvement (sites outside lymph nodes, spleen, and Waldeyer's ring).
  4. Select whether serum LDH is normal or elevated (above the upper limit of normal), and whether bulky disease (≥ 10 cm) is present.
  5. Optionally specify cell of origin (GCB vs. ABC by Hans algorithm or gene expression profiling) and double-hit status from FISH, then click 'Calculate Prognosis'.

DLBCL预后计算器常见问题

什么是国际预后指数（IPI）？
The International Prognostic Index is the most widely used prognostic tool for aggressive non-Hodgkin lymphoma, originally developed in 1993 from a large international multicentre study. It assigns one point each for age above 60, ECOG performance status ≥ 2, elevated LDH, more than one extranodal site, and Ann Arbor stage III or IV disease. Scores of 0–1 define the Low risk group, 2 the Low-Intermediate group, 3 the High-Intermediate group, and 4–5 the High risk group.
什么是修订版IPI（R-IPI）？
The R-IPI was developed in 2007 using rituximab-containing immunochemotherapy cohorts and identified three rather than four prognostic groups. A score of 0 defines a 'Very Good' group with approximately 94% 4-year overall survival. Scores of 1–2 define a 'Good' group (~79% 4-year OS), and scores of 3–5 define a 'Poor' group (~55%). The R-IPI was designed to better reflect outcomes in the modern rituximab era compared with the original IPI.
淋巴瘤的Ann Arbor分期如何运作？
Ann Arbor staging classifies lymphoma by the distribution of involved lymph node regions and extranodal sites. Stage I involves a single lymph node region or a single extranodal site. Stage II involves two or more lymph node regions on the same side of the diaphragm. Stage III involves regions on both sides of the diaphragm. Stage IV involves diffuse extranodal involvement or one extranodal site with distant nodal disease. The 'E' modifier is added for contiguous extranodal extension, and 'B' for systemic symptoms.
什么是双打击淋巴瘤，为什么重要？
Double-hit lymphoma (DHL) is defined by concurrent chromosomal translocations involving MYC with either BCL2 or BCL6, identified by FISH. It constitutes 5–10% of newly diagnosed DLBCL but is associated with significantly worse outcomes than IPI score alone predicts — 2-year overall survival rates of 30–50% with standard R-CHOP chemotherapy. This calculator flags double-hit status as a separate adverse finding, and patients with DHL are typically considered for intensified regimens such as DA-EPOCH-R.
什么是ECOG体能状态？
ECOG performance status is a standardised scale assessing the functional capacity of cancer patients. Grade 0 is fully active with no restriction. Grade 1 is restricted in physically strenuous activity but ambulatory and able to carry out light work. Grade 2 is ambulatory and capable of self-care but unable to carry out work activities; up and about more than 50% of waking hours. Grade 3 is capable of only limited self-care and confined to bed or chair more than 50% of waking hours. Grade 4 is completely disabled and confined to bed. ECOG ≥ 2 contributes one IPI point.
现代治疗是否改变了IPI生存率估计？
Yes. The original IPI survival estimates were derived from pre-rituximab cohorts (before 1993). The addition of rituximab to CHOP chemotherapy (R-CHOP) improved outcomes across all IPI groups by approximately 10–15 percentage points. Emerging therapies including CAR-T cell therapy (axicabtagene ciloleucel, lisocabtagene maraleucel), bispecific antibodies (glofitamab, epcoritamab), and polatuzumab vedotin-based combinations continue to improve salvage outcomes. The survival estimates shown are approximate historical benchmarks and should be interpreted in light of current available therapies.