中枢神经系统淋巴瘤患者的临床分析  

Clinical analysis of patients with central nervous system lymphoma

作　　者：潘佳琪[1] 王巍[1] 赵薇薇 陈丽艳[1] 姜华[1] Pan Jiaqi;Wang Wei;Zhao Weiwei;Chen Liyan;Jiang Hua(Department of Hematology,Second Affiliated Hospital of Harbin Medical University,Harbin 150000,Heilongjiang Province,China)

机构地区：[1]哈尔滨医科大学附属第二医院血液内科,哈尔滨150000

出　　处：《国际输血及血液学杂志》2023年第2期135-140,共6页International Journal of Blood Transfusion and Hematology

基　　金：北京红心相通公益基金2020(202001);黑龙江省省属高等学校基本科研业务科研项目(0202-31041180082)。

摘　　要：目的探讨中枢神经系统淋巴瘤(CNSL)患者的临床特征和预后。方法选择2010年1月至2021年12月哈尔滨医科大学附属第二临床医学院血液内科收治的56例CNSL患者为研究对象。根据患者的CNSL类型, 将其分为原发性CNSL(PCNSL)组(n=30)和继发性CNSL(SCNSL)组(n=26)。采用回顾性研究方法, 收集所有患者的病理分型、治疗前国际预后指数(IPI)评分、β2-微球蛋白(MG)值、乳酸脱氢酶(LDH)水平及Ki-67表达水平等临床资料, 并计算患者的总体有效率(ORR)。采用log-rank检验比较2组患者的总体生存(OS)曲线;采用Cox比例风险回归模型, 对影响患者预后的临床特征进行单因素和多因素分析。2组患者的性别、年龄、病理分型构成比等基线资料比较, 差异均无统计学意义(P>0.05)。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PCNSL组和SCNSL组患者的IPI评分构成比比较, 差异有统计学意义(χ^(2)=13.303, P<0.001)。2组患者的病理分型构成比比较, 差异无统计学意义(χ^(2)=7.168, P=0.127), 均以弥漫大B细胞淋巴瘤(DLBCL)为主, 分别占96.7%(29/30)和73.1%(19/26)。②本研究52例可评估疗效CNSL患者的ORR为61.5%(32/52)。PCNSL组患者的ORR为75.0%(21/28), 高于SCNSL组的45.8%(11/24), 并且差异有统计学意义(χ^(2)=0.465, P=0.031)。③本研究56例患者的OS期为(24.0±4.5)个月, PCNSL组患者的2年OS率为56.6%, 高于SCNSL组的25.7%, 并且差异有统计学意义(χ^(2)=8.970, P=0.003)。④ Cox风险比例回归模型的单因素及多因素分析结果显示, 放疗联合化疗为CNSL患者OS的独立保护因素(HR=0.258, 95%CI:0.097~0.687, P=0.007)。结论 DLBCL为CNSL患者的主要病理亚型, 放疗联合化疗治疗方式为CNSL患者预后的独立保护因素。PCNSL患者疗效优于SCNSL患者。Objective To investigate clinical characteristics and prognosis of patients with central nervous system lymphoma(CNSL).Methods From January 2010 to December 2021,a total of 56 patients with CNSL who were admitted to the Department of Hematology,Second Affiliated Hospital of Harbin Medical University were selected as the study subjects.According to the type of CNSL,patients were divided into primary CNSL(PCNSL)group(n=30)and secondary CNSL(SCNSL)group(n=26).Using a retrospective study method,clinical data were collected from all patients,including pathological type,international prognostic index(IPI)score before treatment,β2-microglobulin(MG)value,lactate dehydrogenase(LDH)level,Ki-67 expression level,and overall response rate(ORR).The comparison of overall survival(OS)curves between two groups was conducted by log-rank test.Univariate and multivariate analyses using Cox proportional hazards regression model were performed to identify clinical characteristics affecting the prognosis of patients.There were no statistically significant differences in the baseline data such as composition ratios of gender,age,and pathological type between two groups(P>0.05).This study was in line with World Medical Association Declaration of Helsinki revised in 2013 and informed consents were obtained from the subjects.Results①There was a statistically significant difference in the composition ratios of IPI scores between PCNSL group and SCNSL group in this study(χ^(2)=13.303,P<0.001).There was no statistically significant difference in the composition ratios of pathological types between patients in two groups(χ^(2)=7.168,P=0.127).And the pathological type of patients in both groups was mainly diffused large B cell lymphoma(DLBCL),accounting for 96.7%(29/30)and 73.1%(19/26),respectively.@The ORR of 52 evaluable CNSL patients in this study was 61.5%(32/52).The ORR of patients in PCNSL group was 75.0%(21/28),which was higher than that of 45.8%(11/24)in SCNSL group,and the difference was statistically significant(χ^(2)=0.465,P=0.

关 键 词：放射疗法 诱导化疗 淋巴瘤 中枢神经系统 预后 原发性中枢神经系统淋巴瘤 继发性中枢神经系统淋巴瘤 

分 类 号：R733.1[医药卫生—肿瘤]