42例原发性中枢神经系统淋巴瘤患者预后影响因素分析  

Analysis of prognostic factors in 42 cases of primary central nervous system lymphoma

作　　者：李盼盼 张卓[1] LI Panpan;ZHANG Zhuo(Department of Radiation Oncology,the Second Affiliated Hospital of Dalian Medical University,Dalian 116023,Liaoning Province,China)

机构地区：[1]大连医科大学附属第二医院肿瘤放疗科,辽宁大连116023

出　　处：《中国癌症杂志》2021年第12期1194-1201,共8页China Oncology

摘　　要：背景与目的:原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)是发生在脑、脊髓、脑膜或眼的罕见侵袭型非霍奇金淋巴瘤,无CNS之外的部位累及。PCNSL与其他类型淋巴瘤相比,患者生存期短,预后差,且复发率高,未经治疗的患者的中位生存期仅为3个月。近年来研究发现C-MYC、BCL-2、BCL-6、Ki-67等指标在一定程度上影响PCNSL患者预后。因此,通过分析PCNSL相关蛋白表达、治疗方式及其他临床因素对患者预后的影响,希望为该病的临床治疗及预后评价进一步积累资料。方法:回顾性分析自2013年6月—2021年5月于大连医科大学附属第二医院治疗的42例经病理学检查明确诊断为原发性中枢神经系统弥漫大B细胞淋巴瘤患者的临床资料,包括性别、年龄、病灶数量、美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)评分、血清乳酸脱氢酶(lactate dehydrogenase,LDH)、病灶是否累及深部脑组织、治疗方案、病理学Hans分型及C-MYC、BCL-2、BCL-6、Ki-67等生物标志物,结合随访调查,了解患者生存时间及生存状况,应用Kaplan-Meier法及log-rank检验分析影响患者无进展生存期(progression-free survival,PFS)和总生存期(overall survival,OS)的预后相关因素,多因素分析采用COX回归模型。结果:42例PCNSL患者中位发病年龄61岁,男女比例为1.33∶1.00,颅脑增强MRI病灶多呈均匀明显强化。所有患者均接受含有大剂量甲氨蝶呤(high-dose methotrexate,HD-MTX)方案化疗,治疗后评价完全缓解(complete response,CR)20例、部分缓解(partial response,PR)5例,疾病稳定(stable disease,SD)11例,疾病进展(progressive disease,PD)6例。中位PFS为21个月,中位OS为34个月,1年PFS率为63.7%,2年PFS率为47.0%;1年OS率为70.8%,2年OS率为55.6%。单因素分析结果显示,影响PFS的因素是HD-MTX多药联合化疗、鞘内化疗及联合利妥昔单抗。影响OS的因素是ECOG评分≥2、C-MYC(+)、BBackground and purpose:Primary central nervous system lymphoma(PCNSL)is a rare aggressive type of non-Hodgkin's lymphoma that occurs in the brain,spinal cord,meninges or eyes,without parts outside of central nervous system(CNS)involvement.Compared with other types of lymphoma,PCNSL has shorter survival time,poor prognosis and high recurrence rate.The median survival time of untreated patients is only 3 months.In recent years,studies have found that C-MYC,BCL-2,BCL-6,Ki-67 and other indicators affect the prognosis of PCNSL patients to a certain extent.Therefore,this study analyzed the effects of PCNSL-related protein expression,treatment methods and other clinical factors on the prognosis of patients,hoping to accumulate data for the clinical treatment and prognosis evaluation of the disease.Methods:In this study,we performed a retrospective analysis of the clinical data of 42 patients with primary central nervous system diffuse large B-cell lymphoma treated in the Second Affiliated Hospital of Dalian Medical University from June 2013 to May 2021,including gender,age,number of lesions,Eastern Cooperative Oncology Group(ECOG)score,serum lactate dehydrogenase(LDH),whether the lesion involves deep brain tissue,treatment plan,pathological Hans classification and C-MYC,BCL-2,BCL-6,Ki-67 and other biomarkers,combined with follow-up investigation,to understand the survival time and survival status of patients.Kaplan-Meier method and log-rank test were used to analyze the prognostic factors affecting progression-free survival(PFS)and overall survival(OS).COX regression model was used in multivariate analysis.Results:The median age of onset in 42 patients with PCNSL was 61 years,and the male to female ratio was 1.33:1.00.Most of the brain-enhanced magnetic resonance imaging(MRI)lesions showed homogeneous and obvious enhancement.All patients received chemotherapy with high-dose methotrexate(HD-MTX)regimen.After treatment,there were 20 cases of complete response(CR),5 cases of partial remission(PR),11 cases of stable disease

关 键 词：原发性中枢神经系统淋巴瘤/PCNSL 弥漫大B细胞淋巴瘤 化疗 预后 

分 类 号：R733.4[医药卫生—肿瘤]