Prognostic Implications of CD14 Antigen Expression in De Novo Acute Myeloid Leukemia

The expression of the CD14 surface antigen in acute myeloid leukemia (AML) has previously been regarded as an indicator of poor overall survival. However, the existing evidence is limited, and further investigations into additional prognostic parameters are necessary. This study aimed to evaluate the impact of the CD14 antigen on survival prognosis in patients with de novo AML ( dn -AML). We analyzed CD14 antigen expression in diagnostic samples from 709 patients with dn-AML by flow cytometry. By utilizing a 20% positivity threshold, the cohort was stratified into CD14-positive (10.15%) and CD14-negative (89.85%) groups. We compared continuous data by using the independent sample t test or Mann‒Whitney U test and used the chi‒square test or Fisher’s exact test to compare categorical variables. OS and DFS were compared via Kaplan‒Meier survival curve analysis and the log-rank test. Univariate and multivariate analyses were performed by using the Cox proportional hazards model, and a visualized nomogram was developed to predict OS. Compared with the CD14-negative group, the CD14-positive group had a lower complete remission rate ( P  < 0.001), a higher relapse rate ( P  = 0.013) and a higher mortality rate ( P  = 0.017). According to the log-rank test, the CD14-positive group exhibited significantly shorter overall survival (OS) ( P  = 0.034) and disease-free survival (DFS) ( P  = 0.009) than the CD14-negative group did. Multivariate analysis revealed that CD14 status, TP53 mutation, European Leukemia Net (ELN) risk category, bone marrow transplant status, white blood cell (WBC) count and hemoglobin levels were independent prognostic factors associated with OS. The visualized nomogram demonstrated notable performance in predicting OS, with a C-index of 0.77. Compared with the ELN risk model, calibration plots and decision curve analyses indicated superior discrimination, calibration and net benefits. The time-dependent receiver operating characteristic (ROC) curves for 1-, 2-, and 3-year survival also performed robustly (AUC = 0.727, 0.738, and 0.753, respectively). Our study provides a comprehensive perspective on the role of the CD14 antigen as an independent prognostic marker in dn -AML patients. This prognostic model leverages readily available clinical data to increase predictive accuracy, identify potential risks and support AML therapeutic decision-making.