31例老年套细胞淋巴瘤的临床特点及预后相关因素  

Clinical features and prognosis relevant factor of 31 elderly patients with mantle cell lymphoma

作　　者：杨朋[1] 李艳[2] 蔡存伟[3] 邹志英[1] 

机构地区：[1]沈阳市第四人民医院干诊科,辽宁沈阳110031 [2]中国医科大学附属第一医院血液科,辽宁沈阳110001 [3]辽宁省肿瘤医院病理科,辽宁沈阳110042

出　　处：《中国医药导报》2014年第33期67-70,74,共5页China Medical Herald

摘　　要：目的 探讨老年套细胞淋巴瘤（MCL）的临床特征、治疗方案效果及影响预后因素.方法 回顾性分析2004年7月～2013年7月沈阳市第四人民医院收治的31例老年MCL患者的年龄、B症状、Ann-Arbor分期、体能状态ECOG评分、结外受累、肝脾肿大、骨髓浸润、国际预后指数（IPI）评分、乳酸脱氢酶（LDH）、β2-微球蛋白（β2-MG）、Ki-67指数、治疗方案等临床资料,总结临床特点并进行相关预后因素分析.结果 全部患者中位发病年龄74.6岁,男女比例3.4∶1,Ann Arbor分期Ⅲ～Ⅳ期29例（93.5％）,有B症状者21例（67.7％）,ECOG评分2～4分19例（61.3％）,骨髓浸润24例（77.4％）,结外累及11例（35.5％）,脾肿大者16例（51.6％）,1PI评分≥3分者26例（83.9％）,LDH升高者19例（61.3％）,β2-MG升高者18例（58.1％）,22例患者进行了Ki-67值检测,Ki-67＞40％者占59.1％;利妥昔单抗联合CHOP组有效率为76.5％,明显高于CHOP组（42.8％）,且3年总生存率及2年无进展生存率均优于后者（P＜ 0.05）.多因素分析显示：B2-MG、骨髓浸润、Ki-67值、治疗方案是独立的预后因素（P＜0.05）.结论 老年MCL具有肿瘤分期晚、疗效差、生存期短等特点.B2-MG升高、骨髓浸润、Ki-67值＞40％、治疗方案是预后的不良危险因素,利妥昔单抗联合化疗能提高疗效及改善预后.Objective To study the clinical features, effect of the therapeutic regimen and prognositic factors of elderly patients with mantle cell lymphoma （MCL）. Methods Clinical data including the age, Ann-Arbor staging, B symptoms, ECOG score of performance status, exfranodal invasion, bone marrow invasion, hepatosplenomegaly, international prog- nostic index （IPI） score, lactate dehydrogenase （LDH）, 132-microglobulin （132-MG）, Ki-67 index, therapeutic regimen of 31 cases of elderly MCL patients admitted by the Fourth People＇s Hospital of Shenyang City from July 2004 to July 2013 were retrospectively analyzed, and clinical feature and prognosis were analyzed. Results Of all patients, median age was 74.6 year-old and male to female ratio was 3.4：1, 29 cases （89.4%） were in Ann Arbor stage Ⅲ-Ⅳ, 21 cases （67.7%） with B symptoms, 24 cases （77.4%） with bone marrow invasion, 11 cases （35.5%） with extranodal invasion, 16 cases （51.6%） with hepatosplenomegaly, 26 cases （83.9%） with IPI I〉3, 19 cases （61.3%） with elevated LDL, and 18 case （58.1%） with elevated β2-MG. Ki-67 was detected in 22 cases, and patients with Ki-67〉40% accounted for 59.1%. The overall response rate of Rituximab combined with CHOP chemotherapy was 76.5%, which was higher than thar of CHOP （42.8%）. There were statistical differences in the 3-years overall survival （OS） rate and 2-year progression free survival （PFS） rate between Rituximab combined with CHOP chemotherapy and CHOP chemotherapy （P 〈 0.05）. COX regression multiple-factor analysis indicated β2-MG, bone marrow invasion, Ki-67 index, therapeutic regimen were the separate hazardous factors which affect the prognosis of elderly patients with MCL （P 〈 0.05）. Conclusion The elderly patients with MCL have characteristics of late tumor staging, poor curative effect, short survival time. β2-MG, bone marrow invasion, Ki-67 index〉40%, therapeutic regimen are the separate hazardous factors which affect the prognosis of

关 键 词：老年患者 套细胞淋巴瘤 临床特点 预后 生存分析 

分 类 号：R733.4[医药卫生—肿瘤]