利妥昔单抗治疗弥漫大B细胞淋巴瘤骨髓浸润患者预后列线图的构建及预测效果  

Establishment of prognostic nomogram in diffuse large B-cell lymphoma patients with bone marrow infiltration treated by rituximab and its predictive effect

作　　者：赵瑾[1] 郭晓静[1] 郑美婧[1] 苏丽萍[1] Zhao Jin;Guo Xiaojing;Zheng Meijing;Su Liping(Department of Hematology,Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China)

机构地区：[1]山西省肿瘤医院,中国医学科学院肿瘤医院山西医院,山西医科大学附属肿瘤医院血液科,太原030013

出　　处：《肿瘤研究与临床》2022年第6期449-454,共6页Cancer Research and Clinic

摘　　要：目的探讨构建的利妥昔单抗治疗弥漫大B细胞淋巴瘤(DLBCL)骨髓浸润患者预后列线图的预测效果。方法回顾性分析2014年1月至2016年6月山西省肿瘤医院收治的接受利妥昔单抗一线治疗的71例DLBCL骨髓浸润患者的临床病理资料。采用Kaplan-Meier法进行无进展生存(PFS)分析, 采用单因素及多因素Cox比例风险模型分析PFS影响因素;基于Cox回归分析的PFS独立影响因素, 采用R软件绘制列线图。应用受试者工作特征(ROC)曲线评估列线图模型预测患者PFS的效果;采用Bootstrap法进行模型的内部验证;绘制列线图校准曲线, 比较列线图模型预测与实际PFS的一致性。结果所有患者中位随访48个月(12~84个月), 3年、5年PFS率分别为39.44%、26.76%。年龄>60岁(HR=1.593, 95%CI 1.379~1.840, P<0.001)、Ann-Arbor分期Ⅲ~Ⅳ期(HR=1.444, 95%CI 1.092~1.910, P=0.010)、国际预后指数(IPI)评分3~5分(HR=1.648, 95%CI 1.249~2.333, P<0.001)、合并2型糖尿病(HR=5.880, 95%CI 1.645~21.023, P=0.006)是DLBCL骨髓浸润患者PFS的独立影响因素。采用PFS独立影响因素建立预后列线图模型, 经Bootstrap法内部验证显示, 预测模型一致性指数为0.71(95%CI 0.69~0.78);ROC曲线显示, 利用列线图模型预测3年PFS的曲线下面积(AUC)为0.708, 预测5年PFS的AUC为0.716, 提示列线图模型具有较好的区分度;校准曲线显示列线图模型预测3年、5年PFS率与实际3年、5年PFS率具有较好的一致性。结论由年龄、Ann-Arbor分期、IPI评分、是否合并2型糖尿病构建的列线图模型可能用于预测利妥昔单抗治疗DLBCL骨髓浸润患者的预后, 有利于辅助临床医师制定治疗策略。Objective To investigate the predictive efficacy of the established prognostic nomogram of rituximab in treatment of diffuse large B-cell lymphoma(DLBCL)patients with bone marrow infiltration.Methods The clinicopathological data of 71 DLBCL patients with bone marrow infiltration who received first-line treatment with rituximab between January 2014 and June 2016 in Shanxi Province Cancer Hospital were retrospectively analyzed.Progression-free survival(PFS)analysis was performed by using Kaplan-Meier method,and influencing factors of PFS were analyzed by using univariate and multivariate Cox proportional hazards models.The nomogram was drawn with R software based on independent influencing factors of PFS from Cox regression analysis.Receiver operating characteristic(ROC)curve was applied to evaluate the effects of nomogram models predicting the PFS of patients;Bootstrap method was used for internal validation of the model.A nomogram calibration curve was plotted to compare the consistency between the nomogram model prediction and the actual PFS.Results The median follow-up time of all patients was 48 months(12-84 months),and the 3-year and 5-year PFS rates were 39.44%and 26.76%,respectively.Age>60 years(HR=1.593,95%CI 1.379-1.840,P<0.001),Ann-Arbor stagingⅢ-Ⅳ(HR=1.444,95%CI 1.092-1.910,P=0.010),international prognostic index(IPI)score 3-5(HR=1.648,95%CI 1.249-2.333,P<0.001),complicated with type 2 diabetes(HR=5.880,95%CI 1.645-21.023,P=0.006)were independent influencing factors of PFS in DLBCL patients with bone marrow infiltration.The independent influencing factors of PFS were included to establish the prognostic nomogram model.Bootstrap method internal validation showed that the consistency index of the prediction model was 0.71(95%CI 0.69-0.78),and the ROC curve showed that the area under the curve(AUC)of 3-year PFS predicted by nomogram model was 0.708,5-year PFS predicted by nomogram model was 0.716,indicating that nomogram model had a good degree of differentiation;and the calibration curve results showe

关 键 词：淋巴瘤 大B细胞 弥漫性 肿瘤侵润 骨髓 预后 列线图 利妥昔单抗 

分 类 号：R733.1[医药卫生—肿瘤]