老年T／NK细胞淋巴瘤预后相关因素的研究  

Study of prognostic related factors of elderly patients with T/NK cell lymphoma

作　　者：王勇[1,2] 钱樱[1] 吴丽莉[3] 赵冰冰[1] 许彭鹏[1] 赵维莅[1] 王黎[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院血液科,200025 [2]江苏省昆山市第三人民医院血液肿瘤科,215300 [3]上海交通大学医学院附属瑞金医院病理科,200025

出　　处：《中华血液学杂志》2013年第1期12-15,共4页Chinese Journal of Hematology

基　　金：国家自然科学青年基金（81101793、81172254）;上海交通大学医学院附属瑞金医院优秀青年教师培养计划;上海市科委基金（09411963000、1lJCl407300）

摘　　要：目的探讨老年T／NK细胞淋巴瘤的预后相关因素。方法收集上海交通大学医学院附属瑞金医院12年来收治的62例老年T／NK细胞淋巴瘤患者的临床资料，按AnnArbor分期、临床状态、结外累及、骨髓浸润状况、LDH水平等指标应用COX回归模型进行预后相关因素的单因素和多因素统计分析。通过IPI或PIT分层系统对T／NK细胞淋巴瘤患者进行危险度分层，不同危险度组患者的总生存时间应用Log—rank检验进行组间比较。结果根据IPI评分分组，低危组（IPI=1）、低中危组（IPI=2）、高中危组（IPI=3）、高危组（IPI=4～5）患者分别有7、22、13、20例，其完全缓解（CR）率分别为85．7％、59．1％、0、5．0％；中位总生存（OS）期分别为90．0、63．9、10．1和5．0个月，IPI为1～2分的患者中位OS期明显长于IPI为3～5分的患者（P〈0．01），但IPI=1分和IPI=2分的患者比较，差异无统计学意义（P=0．3647）。应用PIT评分系统，PIT为1分、2分、3—4分的患者分别有18、18、26例，其CR率分别为61．1％、44．4％、3．8％；中位OS期分别为90．0、46．9和5．0个月，三组患者生存期差异均具有统计学意义（P〈0．01）。单因素分析显示，B症状（P=0．025）、LDH水平升高（P=0．004）、骨髓浸润（P=0．023）和结外浸润（P：0．033）与患者OS期短显著相关。多因素分析显示，LDH水平升高（P=0．007）和骨髓浸润（P=0．016）是2个独立的预后指标，而且这两个因素正是PIT分层的重要指标。结论在老年T／NK细胞淋巴瘤患者中，PIT比IPI具有更好的预后指示作用。Objective To analyze the prognostic related factors of elderly patients with T/NK cell lymphoma. Methods The clinical data of 62 T/NK cell lymphoma patients with age over 60 years and trea- ted in Shanghai Jiaotong University Medical School affiliated Ruijin Hospital from 1999 to 2011 were collected and analyzed. Multivariate and univariate analysis of clinical data were performed using a COX regression model, including stage, performance status, extranodal infiltration, bone marrow involvement and LDH level. According to IPI or PIT systems, survival functions were estimated using the Kaplan-Meier method and com- pared by the log-rank test. Results Using the IPI system, the CR rate of the low risk （ IPI = 1, n = 7）, in- termediate-low risk （ IPI = 2, n = 22） , intermediate-high risk （ IPI = 3, n = 13） and high risk （ IPI = 4 - 5, n =20） groups were 85.7% , 59. 1% , 0% and 5.0% , with the median overall survival （OS） of 90.0, 63.9, 10.1 and 5.0 months, respectively. The patients with IPI--1 -2 had significant longer OS than those with IPI = 3 - 5 （P 〈 0.01 ）, but no significant difference of OS was observed between IPI = 1 and IPI = 2 （P=0.3647）. As for the PIT system, CR rate of patients with PIT = 1 （n = 18）, PIT =2 （n = 18） and PIT =3 -4 （n =26） were 61.1%, 44.4% and 3.8% , with the median survival of 90.0, 46.9 and 5.0 months, respectively. Significant difference of OS was found among groups of PIT = 1, PIT = 2 and PIT = 3 - 4 （P 〈 0.01 ）. Therefore, PIT index was more effective than IPI in predicting prognosis of elderly T/NK cell lymphoma patients. The significant parameters of the univariate analysis were B symptom （ P = 0. 025 ）, in- creased LDH level （ P = 0. 004）, bone marrow infiltration （ P = 0. 023 ） and extranodal involvements （ P = 0. 033 ）. Multivariate analysis showed that only increased LDH level （ P = 0. 007） and bone marrow involve- ment { P = 0.016） were the two independent proznostic factors of survival. These two factors w

关 键 词：老年人 T NK细胞淋巴瘤 预后 

分 类 号：R733.1[医药卫生—肿瘤]