初诊CD5阳性弥漫大B细胞淋巴瘤患者临床特征及预后分析  

Clinical characteristics and prognostic analysis of newly diagnosed CD5⁃positive diffuse large B⁃cell lymphoma

作　　者：唐宇宏 刘佳佳 司阳 王育丽[2] 张彦芳 魏蓉[1] Tang Yuhong;Liu Jiajia;Si Yang;Wang Yuli;Zhang Yanfang;Wei Rong(Department of Hematology,Tenth People's Hospital of Tongji University,Shanghai 200072,China;Department of Hematology,Ninth People's Hospital of Shanghai Jiaotong University School of Medicine,Shanghai 201900,China)

机构地区：[1]同济大学附属第十人民医院血液科,上海200072 [2]上海交通大学医学院附属第九人民医院血液科,上海201900

出　　处：《白血病．淋巴瘤》2023年第9期520-523,共4页Journal of Leukemia & Lymphoma

摘　　要：目的探讨初诊CD5阳性弥漫大B细胞淋巴瘤(DLBCL)患者的临床特征及预后。方法回顾性分析2015年1月至2018年12月同济大学附属第十人民医院和上海交通大学医学院附属第九人民医院收治的19例初诊CD5阳性DLBCL患者的临床资料,分析患者临床特征及实验室指标等,并采用Kaplan⁃Meier法进行生存分析,采用Cox比例风险模型对预后影响因素进行多因素分析。结果19例初诊CD5阳性DLBCL患者中位年龄63岁(34~76岁),其中Ann Arbor分期Ⅲ~Ⅳ期13例,乳酸脱氢酶高于正常值上限12例,国际预后指数评分≥4分9例,存在B症状13例,Ki⁃67阳性指数≥80%10例,存在≥1处淋巴结外器官受累15例,存在大包块(肿块长径≥7 cm)8例。患者2年无进展生存率为47.4%,2年总生存率为63.2%。单因素分析显示,Ann Arbor分期、大包块、淋巴结外受累及≥4个周期鞘内注射与总生存均相关(均P<0.05);多因素分析显示,Ann Arbor分期(Ⅰ~Ⅱ期比Ⅲ~Ⅳ期:HR=0.158,95%CI 0.031~0.803,P=0.026)、大包块(肿瘤长径<7 cm比≥7 cm:HR=0.076,95%CI 0.009~0.637,P=0.018)及≥4个周期鞘内注射(是比否:HR=9.130,95%CI 1.062~78.157,P=0.044)均为总生存的独立影响因素。结论初诊CD5阳性DLBCL侵袭性强,易发生结外浸润。Ann Arbor分期Ⅲ~Ⅳ期、存在大包块及未接受≥4个周期鞘内注射是初诊CD5阳性DLBCL患者预后的独立危险因素。Objective To explore the clinical characteristics and prognosis of newly diagnosed CD5⁃positive diffuse large B⁃cell lymphoma(DLBCL).Methods The clinical data of 19 newly diagnosed CD5⁃positive DLBCL patients in Tenth People's Hospital of Tongji University and Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine between January 2015 and December 2018 were retrospectively analyzed.Their clinical characteristics and laboratory indexes were observed;Kaplan⁃Meier method was used for survival analysis,and Cox proportional risk model was used to make multifactor analysis of the prognostic factors.Results The median age of 19 newly diagnosed CD5⁃positive DLBCL patients was 63 years(34-76 years).All 19 patients included 13 cases with Ann ArborⅢ-Ⅳstage;12 cases with lactate dehydrogenase higher than the normal value limit,9 cases with international prognostic index scores≥4,13 cases with B symptoms,10 cases with Ki⁃67 positive index≥80%,15 cases with more than 1 lymph extra nodal organ involvement and 8 cases with tumor mass(mass diameter≥7 cm).The 2⁃year progression⁃free survival(PFS)rate was 47.4%and 2⁃year overall survival(OS)rate was 63.2%.Univariate analysis showed that Ann Arbor stage,tumor mass,lymph extra nodal involvement and≥4 courses of intrathecal injection were associated with OS(all P<0.05).Multivariate analysis showed that Ann Arbor stage(stageⅠ-Ⅱvs.stageⅢ-Ⅳ:HR=0.158,95%CI 0.031-0.803,P=0.026),tumor mass(tumor diameter<7 cm vs.tumor diameter≥7 cm:HR=0.076,95%CI 0.009-0.637,P=0.018)and≥4 courses of intrathecal injection(yes vs.no:HR=9.130,95%CI 1.062-78.157,P=0.044)were independent influencing factors for OS.Conclusions Newly diagnosed CD5⁃positive DLBCL is highly aggressive and susceptible to extra nodal infiltration.Ann Arbor stageⅢ-Ⅳ,tumor mass,and not receiving≥4 courses of intrathecal injection are independent risk factors affecting the prognosis of CD5⁃positive DLBCL patients.

关 键 词：淋巴瘤 大B细胞 弥漫性 CD5抗原 疾病特征 预后 

分 类 号：R733.1[医药卫生—肿瘤]