弥漫大B细胞淋巴瘤125例临床病理分析  

Clinical pathology analysis of 125 patients with diffuse large B-cell lymphoma

作　　者：李蔚冰[1] 林英城[1] 林雯[1] 王鸿彪[1] 林文照[1] 林穗玲[1] 

机构地区：[1]汕头大学医学院附属肿瘤医院内科,广东汕头515031

出　　处：《中华肿瘤防治杂志》2011年第11期877-881,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的：分析弥漫性大B细胞淋巴瘤（DLBCL）临床特点及CHOP方案治疗结果，探讨DLBCL的临床预后因素。方法：回顾性分析125例CHOP类方案初次化疗的DLBCL患者的临床特征，结合随访资料，采用Kaplan-Meier法对生存率进行评估，进一步采用Cox回归模型对单因素分析中有统计学意义的参数进行多因素分析。结果：125例DLBCL患者中，男女比例1．3：1，中位年龄49岁，AnilArbor Ⅲ～Ⅳ期患者占52．0％，LDH升高占42．1％，IPI中高危组（3～5分）占22．6％。首发为浅表淋巴结肿大60．0％，结外器官受侵72．8％。中位化疗5个周期，CR38．4％，PR44．8％。中位随访28．2个月，中位生存期（MST）46．5个月，3和5年生存率分别为51.9％和48．9％。单因素分析显示，≤60岁、AtinArbor Ⅰ～Ⅱ、LDH正常、体能评分好（ECOG0～1）、IPI评分低、未侵及骨髓、肝未受侵、接受放疗、无B症状以及缓解者是DLBCL的良好预后因素。Cox多因素分析显示，IPI评分高（P=0．000）、未行放疗（P=0．045）和未能缓解者（P=0．049）是DLBCL的独立不良预后因素。结论：DLBCL结外侵犯发生率高，IPI评分高、未行放疗和一线治疗未能缓解者预后不良。OBJECTIVE： To analyze the clinical features and out- comes of diffuse large B-cell lymphoma（DLBCL） patients treated with CHOP chemotherapy, and study the clinical prognosis factors of DL BCL. METHODS： Clinical features and follow-up data of 125 previously untreated DLBCL patients underwent with CHOP regiments were ana- lyzed. Kaplan-Meier was applied to assess the survival probability. All parameters statistically significant concluded by univariate analysis were then computed as co-variates for multivariate analysis with Cox regression model. RESULTS： Of the 125 patients, the ratio of males to fe males was approximately 1.3 ： 1, and the median age of patients was 49 years. The Ann Arbor classification showed that 52.0% of cases were of stage Ⅱ and Ⅳ, 42.1% of cases had elevated serum lactate dehydro- genase（LDH）, and 22.6% of patients were in a median and high risk groups of IPI score （3--5 scores）. The superficial lymph nodes in largement as first symptom took 60.0%, and 72.8% appeared extranodal involvement. The median number of chemotherapy cycle was 5, 38.4% a chieved CR and 44.8G achieved PR. Median followed up was 28. 2 months, median overall survival time was 46.5 months, and the 3-year OS and 5-year OS rates were 51.9% and 48.9% ,respectively. Univariate analysis showed that age 460 years old, Ann Arbor stage Ⅰ--Ⅱ , normal LDH level, good performance status （ECOG 0-1）, lower IPI scores, without marrow or liver involvement, receiving radiotherapy, without B symptom and remission were statistically significant favourable prognostic factor. In multivariate analysis only the high IPI scores （P=0. 000）,without radiotherapy （P=0. 045） and not remission （P= 0. 049） were statistically significant unfavourable independent prognostic factors for DLBCL patients. CONCLUTION： The DLBCL patients with high extranodal involvement, high IPI scores, without radiotherapy and not remission will get poor prognosis.

关 键 词：淋巴瘤 大细胞 弥漫型/药物疗法 治疗结果 预后 

分 类 号：R733.1[医药卫生—肿瘤]