Prognostic Value of Pre-Therapy Serum Uric Acid in Diffuse Large B-Cell Lymphoma

Background: High levels of serum uric acid (SUA) have been shown to associate with negative clinical outcome in various malignancies. This study investigates whether SUA, at the time of diagnosis, has a prognostic significance in patients with diffuse large B-cell lymphoma (DLBCL).

Methods: We retrospectively evaluated 167 Chinese patients with newly diagnosed DLBCL under rituximab (R)-CHOP or CHOP-like immune-chemotherapy from January 2008 to July 2016. The optimal cutoff value of SUA was determined by applying receiver operating curve (ROC) analysis. The prognostic influence of SUA and other factors were studied by Kaplan-Meier curve as well as univariate and multivariate Cox proportional analysis. The influence of SUA on the predictive accuracy of IPI score was subsequently calculated using the Harrell's concordance index (c-index).

Results: ROC analysis showed the cutoff value of SUA with best sensitivity and specificity was 6.4mg dl^-1. Increased SUA level shown by Kaplan-Meier curve had a shorter progression free and overall survival (PFS and OS, p<0.001, respectively). In multivariate analysis, an independent significant association between elevated SUA levels and poor clinical outcome for PFS (HR=3.851; 95%CI 1.816-8.167, p<0.001) and OS (HR=4.007; 95%CI 1.884-8.523, p<0.001) was identified. The estimated concordance index, using IPI stratification measures (0.777), improved to 0.837 when SUA was integrated in.

Conclusions: In the present study, we concluded that increased SUA level at diagnosis is an independent predictor for worse clinical outcome in DLBCL patients. Integrating SUA to the IPI score might improve the survival prediction and risk stratification.