中老年血管免疫母细胞性T细胞淋巴瘤患者临床特征及预后影响因素分析  

Analysis of clinical features and prognostic factors in middle and old age patients with angioimmunoblastic T-cell lymphoma

作　　者：胡雪晴[1] 刘辉[2] 王晖[1] 武晓楠[1] 杜俊[3] 张永强[1] 赵赟博[1] Hu Xueqing;Liu Hui;Wang Hui;Wu Xiaonan;Du Jun;Zhang Yongqiang;Zhao Yunbo(Department of Oncology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Hematology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pathology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing100730,China)

机构地区：[1]北京医院肿瘤内科国家老年医学中心中国医学科学院老年医学研究所,100730 [2]北京医院血液科国家老年医学中心中国医学科学院老年医学研究所,100730 [3]北京医院病理科国家老年医学中心中国医学科学院老年医学研究所,100730

出　　处：《中华老年医学杂志》2021年第2期203-207,共5页Chinese Journal of Geriatrics

基　　金：首都临床特色应用(Z171100001017200)。

摘　　要：目的探讨中老年血管免疫母细胞性T细胞淋巴瘤(AITL)患者的临床特征、诊断及治疗。方法回顾性分析,纳入北京医院2008年5月至2017年3月收治的45岁及以上(年龄47~85岁)中老年AITL患者33例,中位年龄64岁,男性54.5%(18例)。收集临床表现、病理、影像及生存资料,分析不同治疗方案的客观有效率(ORR);采用Kaplan-Meier法进行生存分析,Log-Rank检验进行生存率分析,应用Cox比例风险回归模型进行多因素生存分析。结果33例患者中位总生存时间26.0个月(8.5~43.5个月),1年总生存率66.7%(22例),3年总生存率45.5%(15例),5年总生存率24.2%(8例)。一线CHOP样方案(环磷酰胺,多柔比星,长春新碱,泼尼松)化疗ORR为65.5%(19/29),严重不良反应发生率为64.5%(20/31)。单因素分析结果表明,年龄≥60岁、Barthel评分≥90分、美国东部肿瘤协作组(ECOG)评分≥2分、贫血、淋巴瘤预后指数(IPI)评分4~5分、接受西达苯胺治疗是影响中老年AITL患者5年生存率的预后因素(χ^(2)值分别为5.103、4.306、6.004、4.030、6.348、4.080,均P<0.05);Cox多因素分析结果显示,年龄≥60岁和接受西达苯胺治疗是影响中老年AITL患者5年生存率的独立预后因素(OR=0.313、4.964,均P<0.05)。西达苯胺治疗组[12例(36.4%)]患者总生存时间优于无西达苯胺组[21例(63.6%)]患者,差异有统计学意义(P<0.05)。结论AITL临床特征多样且缺乏特异性,初诊多为晚期,5年总生存率较低,60岁以上老年患者预后较差,西达苯胺可改善患者总生存率。Objective To investigate clinical features,diagnosis and treatment of angioimmunoblastic T-cell lymphoma(AITL)in middle and old age patients.Methods This was a retrospective study.A total of 33 middle-aged and elderly patients(a median age of 64 years,range 47~85 years)with AITL admitted to our hospital from May 2008 to March 2017,including 54.5%male(18 cases),were enrolled in this study.Clinical manifestations,pathology,imaging and survival data of patients were collected.The objective response rate(ORR)of patients with different therapeutic regimens was analyzed.The survival analysis was conducted by using the Kaplan-Meier method,the survival rate was analyzed by using the Log-rank method,and multivariate analysis was conducted by using the proportional hazards regression model.Results The median overall survival(OS)was 26.0 months(8.5-43.5 months).The 1-year,3-year and 5-year OS rate was 66.7%(22 cases),45.5%(15 cases)and 24.2%(8 cases),respectively.The ORR of first-line chemotherapy with CHOP-like regimens(cyclophosphamide,doxorubicin,vincristine,prednisone)was 65.5%(19/29)and the incidence of serious adverse reactions was 64.5%(20/31).Single-factor chi-square testing showed that age≥60 years,Barthel score≥90,Eastern Cooperative Oncology Group performance status score(ECOG-PS)≥2,anemia,International prognostic index(IPI)score of 4~5,receiving chidamide treatment were influncing factors for the prognosis in middle-aged and elderly patients with AITL(χ2=5.103,4.306,6.004,4.030,6.348 and 4.080,P<0.05).Cox multivariate analysis showed that age≥60 years and receiving chidamide treatment were independent prognostic factors affecting the 5-year survival rate of middle-aged and elderly AITL patients(OR=0.313 and 4.964,P<0.05).That the OS was better in the group receiving chidamide treatment than in the group without chidamide treatment(P<0.05).Conclusions Clinical features of AITL are diverse and lack of specificity.Most patients present with advanced stage AITL at the initial diagnosis.The 5-year OS rate is

关 键 词：免疫母细胞淋巴结病 预后 

分 类 号：R733.1[医药卫生—肿瘤]