HBsAg(+)弥漫大B细胞淋巴瘤患者的临床特点和预后分析  

Clinical Features and Prognosis of Patients with HBsAg-Positive Diffuse Large B-Cell Lymphoma

作　　者：曾燕 李仁琴 冯薇臻 张智慧 Zeng Yan;Li Renqin;Feng Weizhen;Zhang Zhihui(School of Clinical Medicine,Southwest Medical University,Luzhou 646000,Sichuan,China;Department of Medical Oncology,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China)

机构地区：[1]西南医科大学临床医学院,四川泸州646000 [2]四川省肿瘤临床医学研究中心,四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学附属肿瘤医院肿瘤内科,成都610041

出　　处：《肿瘤预防与治疗》2023年第5期404-414,共11页Journal of Cancer Control And Treatment

基　　金：四川省肿瘤医院优秀青年基金(编号:YB 2021041)。

摘　　要：目的:分析HBsAg(+)弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)患者的临床特点和预后影响因素。方法:回顾性分析四川省肿瘤医院2018年1月至2021年4月77例HBsAg(+) DLBCL患者的临床资料。Kaplan-Meier法绘制生存曲线,Log-rank检验进行单因素生存分析,Cox回归模型进行多因素分析。结果:77例患者中,男性45例(58.4%),女性32例(41.6%),男女比例1.4:1。中位发病年龄55(29~75)岁,其中26例(33.8%)> 60岁,29例(37.7%)结外侵犯≥2处,32例(41.6%)出现B症状,35例(45.5%)Ki-67≥80%,32例(41.6%)淋巴结侵犯区域≥5处,23例(29.9%)表现为大包块(≥7.5 cm),17例(22.1%)脾脏受侵,16例(20.8%)合并胸腔或腹腔积液,13例(16.9%)伴脾大,16例(20.8%)为原发结外淋巴瘤,非生发中心来源(non-germinal center B-cell type,non-GCB)44例(57.1%),26例(33.8%)ECOG评分2~4分,Ann Arbor分期III~IV期47例(61%),35例(45.5%)IPI评分3~5分,血红蛋白<120 g/L 21例(27.3%),乳酸脱氢酶升高(> 250 U/L)37例(48.1%),白蛋白<40 g/L 39例(50.6%),54%的患者(34/63)β2-微球蛋白升高,49.3%(37/75)出现乙型肝炎病毒(hepatitis B virus,HBV)-DNA≥5.0E+002 IU/mL。化疗前29.9%(23/77)的患者丙氨酸氨基转移酶升高,37.7%(29/77)的患者门冬氨酸氨基转移酶升高,化疗期间64.5%(49/76)的患者转氨酶升高。75例患者的1、2、3年无进展生存率(progress free survival,PFS)分别为84.0%、77.8%、74.5%,1、2、3年总体生存率(overall survival,OS)分别为88.0%、79.3%、76.0%。单因素分析显示年龄> 60岁、分期III~IV期、IPI评分3~5分、结外侵犯≥2处、血红蛋白<120 g/L、白蛋白<40 g/L、LDH> 250 U/L、化疗周期0~3是患者PFS和OS的不良预后因素(P <0.05)。多因素分析显示年龄> 60岁、白蛋白<40 g/L、化疗周期0~3是PFS和OS的独立危险因素(P <0.05)。结论:HBsAg(+) DLBCL患者具有发病年龄较低,分期较晚,IPI评分较高、化疗前及化疗期间易出现转氨酶升高的临床特点,在标准一线治疗期间联合抗�Objective:To analyze the clinical characteristics of hepatitis B surface antigen(HBsAg)-positive diffuse large B-cellympho-ma(DLBCL)patients,and factors affecting their prognosis.Methods:We retrospectively reviewed the clinical data of 77 HBsAg(+)DLB-CL patients diagnosed at Sichuan Cancer Hospital from January 2018 to April 2021.Kaplan-Meier method was used to draw survival curves.Log-rank test was used for univariate survival analysis,and Cox regression model was used for multivariate analysis.Results:Among the 77 patients,45(58.4%)were male and 32(41.6%)were female,with a male-to-female ratio of 1.4:1.Twenty-six of the patients were over 60 years(33.8%)at onset,with the median age-at-onset of 55(29~75)years.There were 29 cases(37.7%)with extranodal invasion≥2 sites,32 cases(41.6%)with B symptoms,35 cases(45.5%)with Ki-67≥80%,32 cases(41.6%)with lymph node invasion≥5 sites,23 cases(29.9%)with bulky disease(≥7.5 cm),17 cases(22.1%)with splenic invasion,16 cases(20.8%)with pleural or abdominal effusion,13 cases(16.9%)with splenomegaly,16 cases(20.8%)with primary extranodal lymphoma,44 cases(57.1%)with non-germinal center B-cell type,26 cases(33.8%)with ECOG score of 2~4,47 patients(61%)with Ann Arbor stage III~IV,35 patients(45.5%)with IPI score of 3~5,21 patients(27.3%)with hemoglobin<120 g/L,37 patients(48.1%)with elevated lactate dehydrogenase(>250 U/L).Albumin<40 g/L was found in 39 cases(50.6%).54%(34/63)patients had elevatedβ2-microglobulin.Hepatitis B virus(HBV)-DNA≥5.0E+002 IU/mL was found in 49.3%(37/75)patients.Alanine aminotransferase and aspartate aminotransferase increased in 29.9%(23/77)and 37.7%(29/77)of the patients before chemotherapy,respectively,and aminotransferase increased in 64.5%(49/76)of the patients during chemotherapy.The 1-,2-and 3-year progression-free survival(PFS)rates of 75 patients were 84.0%,77.8%and 74.5%,and the 1-,2-and 3-year overall survival(0S)rates were 88.0%,79.3%and 76.0%.Univariate analysis showed that age>60 years,stage III~IV,IPI score of 3~5,extranodal inv

关 键 词：乙型病毒性肝炎 弥漫大B细胞淋巴瘤 临床特点 预后 

分 类 号：R733.1[医药卫生—肿瘤]