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Annals of Oncology Advance Access published online on June 23, 2009
Annals of Oncology, doi:10.1093/annonc/mdp053
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Validation, revision and extension of the Follicular Lymphoma International Prognostic Index (FLIPI) in a population-based setting

S. A. M. van de Schans1,*, E. W. Steyerberg2, M. R. Nijziel3, G.-J. Creemers4, M. L. Janssen-Heijnen1 and D. J. van Spronsen5

1 Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven
2 Department of Public Health, Erasmus University Medical Centre Rotterdam, Rotterdam
3 Department of Internal Medicine, Máxima Medical Centre, Eindhoven
4 Department of Internal Medicine, Catharina hospital, Eindhoven
5 Department of Internal Medicine, Canisius-Wilhelmina hospital, Nijmegen, The Netherlands

* Correspondence to: S. A. M. van de Schans, Comprehensive Cancer Centre South (IKZ), Eindhoven Cancer Registry, PO box 231, 5600 AE Eindhoven, The Netherlands. Tel: +31-40-2971616; Fax: +31-40-2971610; E-mail: research{at}ikz.nl

Background: The aim of this study was to validate the Follicular Lymphoma International Prognostic Index (FLIPI) in a population-based cohort and to study the relevance of revision and extension of the FLIPI.

Patients and methods: Data of 353 unselected patients, 1993–2002, in the Eindhoven Cancer Registry, were collected. Follow-up was completed up to 1 January 2006. Multiple imputations for missing covariates were used. Validity was assessed by comparing observed to predicted survival of the original model and of a revised model with other prognostic variables.

Results: The original FLIPI stratified our cohort into three different risk groups based on stage, Hb, lactate dehydrogenase, nodal involvement and age. The discrimination between risk groups was not as good as in the original cohort. A model including age in three categories (≤60/61–70/>70 years) and presence of cardiovascular disease (CVD) (yes/no) resulted in a better prognostic index. The 5-year overall survival rates were 79%, 59% and 28% in the low-, intermediate- and high-risk groups for the extended FLIPI compared with 81%, 66% and 47% for the original FLIPI, respectively.

Conclusions: The performance of the FLIPI was validated in a population-based setting, but could significantly be improved by a more refined coding of age and by including the presence of CVD.

comorbidity, FLIPI, population-based, revision, validation

Received for publication October 16, 2008. Revision received February 9, 2009. Accepted for publication February 11, 2009.


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