原发中枢神经系统弥漫大B细胞淋巴瘤的预后及关联因素分析  

Prognosis of primary central nervous system diffuse large B-cell lymphoma and its associated factors

作　　者：武其嘉 孔东生 魏利琴 张宇[1] 晋薇[3] 冯世宇[2] WU Qijia;KONG Dongsheng;WEI Liqin;ZHANG Yu;JIN Wei;FENG Shiyu(Department of Neurosurgery,Affiliated Hospital of Hebei University,Baoding 071000,Hebei Province,China;Department of Neurosurgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100036,China;Department of Pathology,the First Medical Center,Chinese PLA General Hospital,Beijing 100036,China)

机构地区：[1]河北大学附属医院神经外科,河北保定071000 [2]解放军总医院第一医学中心神经外科医学部,北京100036 [3]解放军总医院第一医学中心病理科,北京100036

出　　处：《解放军医学院学报》2023年第6期631-638,共8页Academic Journal of Chinese PLA Medical School

摘　　要：背景原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)是一种罕见的颅内肿瘤,组织学常表现为弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL),目前预后相关因素仍不明确。目的通过回顾性分析患者的临床资料,探讨生存预后的影响因素。方法对2014年7月-2021年1月于解放军总医院第一医学中心新诊断为PCNSL-DLBCL的57例患者进行回顾分析,随访截至2022年7月。进行Kaplan-Meier生存分析,采用Cox回归模型分析预后及关联因素。结果57例PCNSL患者中位年龄为55岁(范围:16~86岁),其中男性34例,女性23例。总体中位无进展生存期(median progression-free survival,mPFS)为34个月,中位总生存期(median overall survival,mOS)为57个月,2年PFS率和OS率分别达到49%和65%;5年PFS和OS分别达到35%和48%。PFS的Cox回归结果显示,血清乳酸脱氢酶(lactate dehydrogenase,LDH)水平升高(HR=4.678,95%CI:1.572~13.925)、病变多发(HR=3.369,95%CI:1.578~7.190)的患者PFS较差;联合利妥昔单抗化疗(HR=0.477,95%CI:0.207~0.926)、接受自体造血干细胞移植(allogeneic stem cell transplantation,ASCT)(HR=0.102,95%CI:0.013~0.794)的患者PFS较长;与单独进行手术相比,接受其他治疗方案的患者PFS更长(穿刺活检+大剂量氨甲蝶呤vs单纯手术切除:HR=0.178,95%CI:0.058~0.544;手术+大剂量氨甲蝶呤vs单纯手术切除:HR=0.153,95%CI:0.050~0.467)。OS的Cox回归结果显示,美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)评分≥2分(HR=3.121,95%CI:1.192~8.170)、病变多发(HR=2.714,95%CI:1.076~6.846)的患者OS较差;与单独进行手术相比,接受其他治疗方案的患者OS更长[穿刺活检+大剂量氨甲蝶呤vs单纯手术切除:HR=0.127,95%CI:0.034~0.471;手术+大剂量氨甲蝶呤vs单纯手术切除:HR=0.070,95%CI:0.018~0.269];接受ASCT(HR=0.138,95%CI:0.017~0.941)的患者OS较长。但进行穿刺活检后综合治疗与手术切除后综合治疗患者的生存预后无统计学�Background Primary central nervous system lymphoma(PCNSL)is a rare intracranial tumor,which often histologically presents as diffuse large B-cell lymphoma(DLBCL).At present,the prognostic factors are still unclear.Objective To explore the related factors of survival and prognosis by retrospectively analyzing the clinical data about 57 patients with newly diagnosed PCNSL.Methods A total of 57 patients newly diagnosed with PCNSL-DLBCL in the First Medical Center of Chinese PLA General Hospital from July 2014 to January 2021 were included,and the follow-up ended in July 2022.Kaplan-Meier survival analysis and Cox regression analysis were used to analyze the prognosis and associated factors.Results The median age of the 57 PCNSL patients was 55 years(range:16 to 86 years),including 34 males and 23 females.The median progression-free survival(mPFS)was 34 months,and the median overall survival(mOS)was 57 months.The 2-year PFS and OS rates were 49%and 65%,respectively.The 5-year PFS and OS were 35%and 48%,respectively.Cox regression analysis showed that serum lactate dehydrogenase(LDH)level(HR=4.678,95%CI:1.572-13.925,P=0.006),with rituximab chemotherapy(HR=0.477;95%CI:0.207-0.926;P=0.042),multiple lesions(HR=3.369;95%CI:1.578-7.190;P=0.002),operation methods(needle biopsy+surgery+HD-MTX vs surgery alone:HR=0.178,95%CI:0.058-0.544,P=0.002;S+HD-MTX vs surgery alone:HR=0.153,95%CI:0.050-0.467,P=0.001)and with allogeneic stem cell transplantation(ASCT)(HR=0.102,95%CI:0.013-0.794,P=0.029)were associated with PFS.Eastern Cooperative Oncology Group(ECOG)score≥2(HR=3.121,95%CI:1.192-8.170,P=0.020),multiple lesions(HR=2.714,95%CI:1.076-6.846,P=0.034),operation methods(needle biopsy+surgery+HD-MTX vs surgery alone:HR=0.127,95%CI:0.034-0.471,P=0.002;surgery+HD-MTX vs surgery alone:HR=0.070,95%CI:0.018-0.269,P<0.001),and with ASCT(HR=0.138,95%CI:0.017-0.941,P=0.046)were associated with OS.However,there was no significant difference in the survival prognosis between the patients who received comprehensive treatment after biopsy a

关 键 词：原发性中枢神经系统淋巴瘤 弥漫大B细胞淋巴瘤 预后因素 生存分析 综合治疗 

分 类 号：R733.4[医药卫生—肿瘤]