弥漫性大B细胞淋巴瘤的临床特征及预后影响因素分析  

Clinical characteristics and prognosis of diffuse large B-cell lymphoma

作　　者：杨渤彦[1] 勇威本[1] 朱军[1] 郑文[1] 张运涛[1] 王小沛[1] 孟松娘[1] 

机构地区：[1]北京大学临床肿瘤学院北京肿瘤医院淋巴血液科

出　　处：《中华肿瘤杂志》2005年第3期174-176,共3页Chinese Journal of Oncology

摘　　要：目的　探讨弥漫性大B细胞淋巴瘤 (DLBCL)的临床特征及其预后的影响因素。方法回顾性分析 138例DLBCL患者的临床特征 ,结合随访资料 ,对DLBCL的预后影响因素进行单因素和多因素分析。结果　 87.7%侵犯淋巴结 ,6 0 .1%有结外侵犯 ,全组 5年生存率为 4 1.3%。多因素分析表明 ,患者年龄、临床分期和近期疗效是DLBCL预后的独立影响因素。国际预后指数 (IPI)计分低危组 5年生存率为 6 1.9% ,低中危组为 4 4 .3% ,高中危组为 2 0 .2 % ,高危组为 9.2 % ,差异有统计学意义(P <0 .0 1)。伴结外侵犯者 ,化疗联合手术治疗 5年生存率为 5 5 .6 % ,明显高于单纯化疗组。结论患者年龄、临床分期和近期疗效是DLBCL预后的独立影响因素 ,结外侵犯病例应采取手术和化疗联合治疗。Objective To investigate the clinical characteristics of diffuse large B cell lymphoma (DLBCL) and the factors affecting its prognosis. Methods From 1994 to 2002, 138 patients with DLBCL were confirmed by morphological and immunohistochemical examination. Sex, age, clinical stage, performance status (PS), serum lactate dehydrogenase(LDH), number of extranodal lesions, treatment response, cycles of chemotherapy, B symptom, erythrocyte sedimentation rate (ESR), 5 year survival rate and median survival time (mST) were included as the analysis indeces. Results Lymph nodes were involved in 87.7% of the patients, and extranodal lesions were found in 60.1%. Five year survival rate was 41.3% for the entire group. Age, stage, PS, serum LDH, number of extranodal lesions,international prognostic index (IPI) and remission rates were significantly correlated with overall survival (OS) and mST ( P <0.05), However, sex, chemotherapy cycles, B symptom, ESR were not related to OS and mST ( P >0.05). Age, stage, remission rates were identified as independent factors affecting the prognosis. Combination of surgery and chemotherapy was quite impressive in the prolongation of survival of patients with extranodal lesions and gastrointestinal lymphoma compared to those by chemotherapy alone. Conclusion Age, stage, PS, serum LDH, number of extranodal lesions, IPI, chemotherapy cycles and remission rates are significant factors affecting the prognosis in DLBCL patients. Age less than 40 years or ≥65 years, Stage Ⅲ Ⅳ, partial remission or progressive disease are demonstrated as poor prognostic factors. Combined treatment is the strategy suggested for DLBCL patients with extranodal lesions.

关 键 词：DLBCL 预后 临床特征 弥漫性大B细胞淋巴瘤 患者 生存率 化疗 结论 独立 国际 

分 类 号：R733.1[医药卫生—肿瘤]