409例初治弥漫大B细胞淋巴瘤患者的生存预后分析  

Analysis of survival and prognosis in 409 newly diagnosed patients with diffuse large B-celllymphoma

作　　者：文菁菁[1,2] 周佳丽[1] 刘志彬[1] 刘霆[1] 徐才刚[1] 

机构地区：[1]四川大学华西医院血液科、血液病研究室,成都610041 [2]四川省绵阳市中心医院血液科,621000

出　　处：《中华血液学杂志》2014年第4期318-324,共7页Chinese Journal of Hematology

摘　　要：目的探讨影响弥漫大B细胞淋巴瘤（DLBCL）患者预后的不良因素。方法收集2000年1月至2010年12月新诊断的409例初治DLBCL患者临床资料，对影响生存的不同因素进行单因素及多因素分层分析。结果409例患者中男244例，女165例，中位年龄56（16～89）岁。中位随访时间为23（2-108）个月。单因素分析结果显示患者年龄、AnnArbor分期、B症状、体能状态ECOG评分、国际预后指数（IVI）评分、骨髓受累、淋巴细胞绝对值计数（ALC）降低、LDH升高、B：微球蛋白较正常升高2倍、治疗方案及近期疗效等对患者总体生存（Os）及无进展生存（pvs）率的影响差异均有统计学意义（P值均〈0．05）。多因素分析结果显示AnnArbor分期Ⅲ～Ⅳ期、LDH升高是影响患者OS与PFS率的不良预后因素（P〈0．05）。当纳入IPI评分时，ALC降低、IPI3-5分是影响CHOP类方案治疗组患者（232例）OS及PFS率的不良因素（P值均〈0．05），修正（R）-IPI评分是影响RCHOP类方案治疗组患者（177例）OS与PFS率的独立预后因素（P〈0．05）。结论AnnArbor分期Ⅲ。Ⅳ期、LDH升高是影响DLBCL患者OS及PFS率的不良预后因素；ALC降低及IPI3-5分是影响CHOP方案治疗患者OS与PFS率的不良预后因素；R-IPI评分是影响RCHOP方案治疗患者OS及PFS率的独立预后因素。Objective To Explore the poor prognostic factors of diffuse large B-cell lymphoma （DLBCL）. Methods The clinical data of 409 newly diagnosed patients with DLBCL from January 2000 to December 2010 were collected, and the prognostic factors by univariate and multivariate stratification were analyzed. Results Of the 409 DLBCL patients, 244 were males and 165 females, the median age was 56 （16-89）years old, the median follow-up time was 23 （2-108） months. In univariate analysis, age, clinical stage, B symptoms, ECOG scores, the international prognostic index （IPI） scores, bone marrow involvement, low absolute lymphocyte count （ALC）, high LDH,β2-MG〉2 times of normal, regimen and therapeutic effect had significant influence on OS and PFS （P〈0.05）. Multivariate analysis showed that stageIII-IV and high LDH were the poor prognostic factors of OS and PFS （P〈0.05）. When IPI scores were included, low ALC and IPI 3-5 scores were the poor predictors of OS and PFS in CHOP-like group （232 cases ）, revised IPI （R-IPI） was an independent poor predictors of O S and PFS in RCHOP-like group （ 177 cases）. Conclusions Stage III-IV and high LDH have negative influence on OS and PFS in patients with DLBCL, low ALC and IPI 3-5 scores affect OS and PFS in CHOP-like group, R-IPI affects OS and PFS in RCHOP-like group.

关 键 词：淋巴瘤 大B细胞 弥漫性 国际预后指数 淋巴细胞计数 存活率分析 预后 

分 类 号：R733.1[医药卫生—肿瘤]