RCHOP方案化疗联合累及野放疗治疗弥漫大B细胞淋巴瘤患者的临床分析  

Clinical analysis of RCHOP regimen combined with involved-field radiotherapy for patients with diffuse large B-cell lymphoma

作　　者：刘依 马盼盼 冯慧 罗敏娜[1] 李欣妍 雷豆 刘海波[1] 牛凡 王晓宁[1] 贺鹏程[1] Liu Yi;Ma Panpan;Feng Hui;Luo Minna;Li Xinyan;Lei Dou;Liu Haibo;Niu Fan;Wang Xiaoning;He Pengcheng(Department of Hematology,First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,Shaanxi Province,China)

机构地区：[1]西安交通大学第一附属医院血液内科,710061

出　　处：《国际输血及血液学杂志》2021年第1期54-62,共9页International Journal of Blood Transfusion and Hematology

基　　金：国家重点研发计划项目(2019YFC1316204);重大新药创制国家科技重大专项(2020ZX09201020);陕西省重点研发计划项目(2018ZDCXL-SF-01-02-01)。

摘　　要：目的探讨对弥漫大B细胞淋巴瘤(DLBCL)患者采取单独RCHOP(利妥昔单抗+环磷酰胺+多柔比星+长春新碱+泼尼松)方案化疗或RCHOP方案化疗后联合累及野放疗(IFRT)治疗的预后及其影响因素。方法选择2013年1月1日至2018年12月31日,于西安交通大学第一附属医院收治的68例临床分期为Ann ArborⅠ~Ⅱ期、非大包块型、接受RCHOP方案化疗的DLBCL患者为研究对象。患者的中位发病年龄为57.0岁(范围:20~83岁);男性患者为39例,女性为29例。根据患者接受RCHOP方案化疗后是否联合IFRT治疗,将其分为RCHOP联合IFRT治疗组(n=22)和RCHOP单独治疗组(n=46)。对2组DLBCL患者的随访均截至2020年2月28日。回顾性分析2组患者的临床病例资料,比较二者预后,并且分析其预后影响因素。2组患者的一般临床资料比较,采用χ^(2)检验。采用Kaplan-Meier法绘制2组患者的总体生存(OS)和无进展生存(PFS)曲线,并且计算其5年OS和PFS率。采用Log-rank检验,比较2组患者的5年OS和PFS率,以及对可能影响患者预后的因素进行单因素分析。采用Cox比例风险回归模型对单因素分析中有统计学意义,或临床经验及文献资料提示有临床意义的影响因素,进行多因素分析。本研究遵循的程序符合2013年修订版《世界医学协会赫尔辛基宣言》要求,并且与所有受试者签署临床研究知情同意书。结果①本研究RCHOP联合IFRT治疗组和RCHOP单独治疗组DLBCL患者的一般临床资料分别比较,差异均无统计学意义(P>0.05)。②对2组DLBCL患者的中位随访时间为31.0个月(23.5~47.0个月)。2组患者的5年OS和PFS率分别比较,差异均无统计学意义(OS率:94.1%比89.9%、χ^(2)=0.279、P=0.598,PFS率:88.2%比77.1%、χ^(2)=0.782、P=0.376)。③对本研究68例DLBCL患者预后影响因素的多因素Cox比例风险回归模型分析结果显示,血清乳酸脱氢酶(LDH)水平>250 U/L(HR=27.033,95%CI:2.256~323.916,P=0.009),Ki-67表达水平≥90%(HRObjective To explore the effect and prognostic factors of clinical treatment in patients with diffuse large B-cell lymphoma(DLBCL)using RCHOP(rituximab+cyclophosphamide+doxorubicin+vincristine+prednisolone)regimen chemotherapy alone or RCHOP regimen chemotherapy combined with involved-field radiotherapy(IFRT).Methods From January 1,2013 to December 31,2018,a total of 68 patients with DLBCL who were admitted to the First Affiliated Hospital of Xi′an Jiaotong University were selected as subjects.All the patients were in clinical stage of Ann ArborⅠ-Ⅱ,with non-large masses,and treated with RCHOP regimen chemotherapy.The patients′median patients age of onset was 57 years(range:20-83 years).Among them,there were 39 male patients and 29 females.Patients were divided into RCHOP combined IFRT treatment group(n=22)and RCHOP treatment alone group(n=46),according to whether combined with IFRT after receiving RCHOP regimen chemotherapy.The follow-up time for the DLBCL patients in two groups was up to February 28,2020.The clinical data of the DLBCL patients in two groups were analyzed,and the efficacy and prognostic factors were compared by retrospective analysis method.The general clinical data of patients in two groups were compared byχ^(2) test.The Kaplan-Meier method was used to draw the overall survival(OS)and progression-free survival(PFS)curves of patients in two groups,and to calculate their 5-year OS and PFS rates.Log-rank test was used to compare the 5-year OS and PFS rates of patients between two groups,as well as to perform univariate analysis of factors that may affect the prognosis of patients.Cox proportional hazards regression model was used to conduct multivariate analysis for the factors that are statistically significant in single factor analysis,or clinical experience and literature data suggest clinical significance.This study was in line with World Medical Association Declaration of Helsinki revised in 2013.Results①In this study,the general clinical data of DLBCL patients between the RCHOP com

关 键 词：淋巴瘤 大B细胞 弥漫性 放射疗法 肿瘤分期 预后 累及野放疗 非大包块 

分 类 号：R733.1[医药卫生—肿瘤]