200例原发韦氏环弥漫大 B 细胞淋巴瘤的治疗及预后  

Clinical outcome and prognosis of Waldeyer’s ring diffuse large B-cell lymphoma：an analysis of 200 patients

作　　者：徐勇刚[1] 李晔雄[2] 王维虎[2] 金晶[2] 王淑莲[2] 刘跃平[2] 宋永文[2] 任骅[2] 房辉[2] 刘清峰[2] 吴润叶[2] 亓姝楠[2] 陈波[2] 

机构地区：[1]北京医院放疗科 [2]北京协和医学院中国医学科学院肿瘤医院放疗科,100021

出　　处：《中华放射肿瘤学杂志》2015年第4期382-386,共5页Chinese Journal of Radiation Oncology

摘　　要：目的：分析原发韦氏环弥漫大 B 细胞淋巴瘤的疗效和预后因素。方法2000—2013年收治200例确诊为原发韦氏环弥漫大 B 细胞淋巴瘤，Ⅰ期50例，Ⅱ期125例，Ⅲ＋Ⅳ期25例。大部分患者接受4～6周期 CHOP 或 CHOP 为主方案化疗以及受累野放疗（韦氏环＋颈部淋巴结区域）。 Kaplan.Meier 法计算 OS、PFS、LRC，Logrank 法检验和单因素分析，Cox 多因素分析。结果5年样本数量71例，全组5年OS、PFS 和 LRC 分别为78％、72％和87％。放化疗组的 OS、PFS、LRC 均高于单纯化疗组，分别为86％∶70％、84％∶58％和97％∶66％（P＝0.001、0.000、0.000）。单因素分析显示年龄、肿瘤大小、分期、LDH 和 IPI 是 OS、PFS 和 LRC 共同预后因素（P＝0．000～0.036），PFS 预后因素还包括 ECOG 评分（P＝0.018）。多因素分析显示年龄和分期是 OS 和 LRC 的预后因素（P＝0．003～0.022），PFS 的预后因素是年龄（P＝000）。结论韦氏环弥漫大 B 细胞淋巴瘤具有独特的临床特征和疗效好的特点。早期患者加入放疗可以显著提高 OS、PFS 和 LRC。Objective To evaluate the clinical features, treatment outcome, and prognostic factors in patients with primary Waldeyer’ s ring diffuse large B.cell lymphoma （WR.DLBCL）. Methods This study included 200 patients with a confirmed diagnosis of primary WR.DLBCL admitted to our hospital from 2000 to 2013, who consisted of 50 stage I patients, 125 stage II patients, and 25 stage III.IV patients. Most patients received 4.6 cycles of CHOP or CHOP.based chemotherapy with or without involved field radiotherapy （Waldeyer′s ring＋cervical lymph node region）. Results The 5.year sample size was 71. The 5.year overall survival （OS）, progression.free survival （PFS）, and locoregional control （LRC） rates for the whole group were 78%, 72%, and 87%, respectively. In the 175 early stage patients, chemoradiotherapy resulted in significantly higher OS, PFS, and LRC than chemotherapy alone （86% vs. 70%, P= 0. 001;84% vs. 58%, P= 0. 000;97% vs. 66%, P= 0. 000）. Univariate analysis showed that age, tumor size, stage, lactate dehydrogenase level, and International Prognostic Index were prognostic factors for OS, PFS, and LRC （ P= 0. 000.0. 036）, while the prognostic factors for PFS also included Eastern Cooperative Oncology Group score and cervical nodal involvement （P= 0. 018）. Multivariate analysis showed that age and stage were prognostic factors for OS and LRC （P= 0. 003.0. 022）, and age was the prognostic factor for PFS （P= 0. 000）. Conclusions WR.DLBCL has distinct clinical features and favorable prognoses. For early stage patients, combined.modality therapy results in significantly higher OS, PFS, and LRC.

关 键 词：漫大 B 细胞淋巴瘤 韦氏环/ 化放疗法 预后 

分 类 号：R733.1[医药卫生—肿瘤]