国际预后评分预测进展期霍奇金淋巴瘤预后的可行性分析  

Feasibility study of application of International Prognostic Score on prediction of prognosis for advanced Hodgkin's lymphoma

作　　者：林华[1] 何小慧[1] 杨晟[1] 杨建良[1] 周生余[1] 刘鹏[1] 秦燕[1] 李博[1] 张长弓[1] 韩晓红[1] 石远凯[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院内科,北京100021

出　　处：《癌症进展》2009年第5期556-562,共7页Oncology Progress

摘　　要：探索应用国际预后评分(IPS)预测进展期霍奇金淋巴瘤(HL)预后的可行性。方法回顾性分析2001年1月～2004年12月中国医学科学院肿瘤医院初次治疗的95例进展期HL,按照确诊时患者不良预后因素的数目计算IPS。采用KaplanMeier法进行生存分析。生存率的比较用log-rank检验,分层研究各亚组的预后意义,按IPS分组计算生存率并进行生存率比较。结果95例进展期HL患者5年无失败生存率(FFS)为64.5%,5年总生存率(OS)为75.3%。按照国际标准分为进展期HL低危病组(IPS 0～2组)和高危病组(IPS≥3组),5年FFS分别为72.0%和33.5%(P=0.041);5年OS分别为77.3%和66.77%(P=0.425)。IPS=0分、1～2分和IPSI≥3分组的5年FFS分别为91.7%、68.3%、33.3%;5年OS分别为91.7%、74.6%、66.7%。单因素分析显示:对FPS有预后意义的因素有血红蛋白水平、血浆白蛋白水平;对OS有预后意义的因素有性别、B症状治疗模式及治疗方案。接受ABVD方案[阿霉素(A)、博来霉素(B)、长春花碱(V)、氮烯咪胺(D)]治疗的进展期HL患者FFS显著优于接受非ABVD方案治疗者,增加剂量化疗和造血干细胞移植的疗效较好,对于高危患者是一种可以选择的治疗方法。结论IPS对进展期HL的预后有较好的预测价值,高危进展期HL患者接受ABVD方案化疗组生存率较接受非ABVD方案化疗组好,因此对于进展期HL推荐应用ABVD方案或更强的方案化疗。Objective Currently 60% patients with advanced Hodgkin＇s lymphoma can be cured by receiving standard treatments. The International Prognostic Factor Project on Advanced Hodgkin＇s Lymphoma has developed a concept of International Prognostic Score （IPS） based on seven adverse prognostic factors consisting of male sex, age （45 years or older）, stage IV disease, leukocytosis, lymphocytopenia, low hemoglobin, and low serum albumin for newly diagnosed advanced Hodgkin＇s lymphoma patients. This study aimed to explore the feasibility of IPS in advanced Hodgkin＇s lymphoma. Methods We performed a retrospective review of 95 patients with untreated advanced Hodgkin＇s lymphoma in our hospital between January 2001 and December 2003. IPS was defined as the number of adverse prognostic factors presented at diagnosis. The rates of failure free survival （FFS） and overall survival （OS） were estimated using Kaplan-Meier method and compared according to IPS by log-rank test. Results The 5 - year FFS and OS for 95 advanced Hodgkin＇s lymphoma patients were 64. 5 % and 75.3% respectively. The estimated 5-year FFS was 91.7%, 68.3%, and 33.3%for patients with 0, 1 - 2, ands〉 3 of the adverse prognostic and factors, respectively. The estimated 5 - year OS was 91.7%, 74. 6%, and 66. 7% for patients with 0, 1 - 2, and ≥ 3 of the adverse prognostic factors, respectively. The 5 - year FFS for low-risk patients with IPS =0 -2 and high risk patients with IPS ≥3 were 72.04% and 33.5%, respectively （P =0. 03） ; the 5-year OS for patients with IPS =0 -2 and IPS≥3 were 77.3% and 66. 7%, respectively （ P = 0. 004）. The FFS of the advanced HL patients at high risk treated with ABVD were better than those treated with non-ABVD regime. Conclusions The IPS shows good prognostic power in advanced Hodgkin＇s lymphoma. Advanced Hodgkin＇s lymphoma patients treated with non - ABVD have inferior survival than those treated with ABVD, thus we recommend patients to be treated with ABVD or more intensive regimen. Hig

关 键 词：霍奇金淋巴瘤 预后 国际预后评分 

分 类 号：R733.4[医药卫生—肿瘤]