弥漫大B细胞淋巴瘤R-CHOP化疗的生存预后评估模型  

Survival prognostic model for diffuse large B-cell lymphoma after R-CHOP chemotherapy

作　　者：翁翔 赵明哲[1] 胡慧仙[1] WENG Xiang;ZHAO Mingzhe;HU Huixian(Department of Hematology,Jinhua Municipal Central Hospital,Jinhua 321000,China)

机构地区：[1]金华市中心医院血液科,321000

出　　处：《浙江医学》2024年第2期172-176,共5页Zhejiang Medical Journal

基　　金：金华市公益性技术应用研究项目(2022-4-094)。

摘　　要：目的建立弥漫大B细胞淋巴瘤(DLBCL)R-CHOP化疗的生存预后评估模型,以指导临床进行风险分层。方法选取2018年1月至2023年1月在金华市中心医院确诊的DLBCL患者210例为研究对象,根据2:1抽样比例随机分为建模集140例和验证集70例。所有患者均接受R-CHOP化疗方案至少4个疗程(21 d为1个疗程),常规随访至2023年6月。根据生存预后分为良好组和不良组。比较两组患者的临床资料[包括性别、年龄、BMI、基础疾病、血清乳酸脱氢酶(LDH)、美国国家综合癌症网络国际预后指数(NCCN-IPI)]、病理特征[包括Hans分型、Ann Arbor分期、原发部位、Ki-67阳性表达率、MYC和B细胞淋巴瘤(Bcl)-2蛋白阳性表达以及骨髓侵犯]、治疗(化疗疗程和并发症)和随访时间。结果建模集中良好组105例和不良组35例,预后不良发生率25.0%;验证集良好组55例和不良组15例,不良发生率21.4%。建模集中不良组年龄大于良好组,LDH水平、NCCN-IPI、Ann Arbor分期Ⅲ~Ⅳ比例、Ki-67阳性表达率、MYC和Bcl-2蛋白双阳性表达率和骨髓侵犯比例均高于良好组,差异均有统计学意义(均P<0.05)。多因素Cox回归分析显示,NCCN-IPI(HR=2.526,95%CI:2.001~3.125,P<0.001)、Ann Arbor分期Ⅲ~Ⅳ(HR=5.021,95%CI:4.125~5.998,P<0.001)、MYC和Bcl-2蛋白双阳性(HR=3.859,95%CI:3.256~4.754,P<0.001)均是DLBCL患者R-CHOP化疗预后不良的危险因素。建立预测模型Y=0.056+1.032×(NCCN-IPI)+1.986×(Ann Arbor分期)+1.434×(MYC和Bcl-2蛋白双阳性)。ROC曲线显示,模型预测建模集与验证集预后不良的AUC分别为0.923和0.866(均P<0.01)。结论DLBCL患者化疗前NCCN-IPI、Ann Arbor分期升高以及MYC和Bcl-2蛋白双阳性表达与R-CHOP化疗预后不良密切相关,通过建立量化预测模型能够辅助临床早期、准确识别预后不良的高危群体,有较好的应用价值。Objective To establish a survival prognosis model for diffuse large B-cell lymphoma(DLBCL)after RCHOP chemotherapy(rituximab,cyclophosphamide,doxorubicin,vincristine,prednisolone)to guide the risk stratification of patients.Methods A total of 210 patients diagnosed as DLBCL in Jinhua Municipal Central Hospital were retrospectively enrolled from January 2018 to January 2023.They were randomly divided into a training set of 140 patients and a validation set of 70 cases based on a ratio of 2:1.All patients received R-CHOP chemotherapy for at least 4 courses of treatment(21 days as 1 course),and were followed up routinely until June 2023.According to the survival prognosis,patients were divided into the favorable and adverse groups.Their clinical information[including gender,age,body mass index,chronic comorbidity,serum lactate dehydrogenase(LDH),National Comprehensive Cancer Network international prognostic index(NCCN-IPI)],pathological characteristics[including Hans classification,Ann Arbor staging,primary sites,Ki-67 positive expression rate,MYC and B-cell lymphoma-2(Bcl-2)protein positive expression,and bone marrow invasion],treatment landscape(chemotherapy course and complications),and follow-up time were compared.Results In the training set,there were 105 cases in the favorable group and 35 cases in the adverse group,with the adverse prognosis rate of 25.0%.In contrast,the validation set consisted of 55 cases in the favorable group and 15 cases in the adverse group,with the adverse prognosis rate of 21.4%.Univariate analyses found that in the training set,patients of the adverse group were older than the favorable group,and their LDH level,NCCN-IPI,ratio of Ann Arbor stages III-IV,positive expression rate of Ki-67,double positive expressions of MYC and Bcl-2 proteins,and ratio of bone marrow invasion were all significantly higher than the favorable group(all P<0.05).Multivariate Cox regression analysis showed that NCCN-IPI(HR=2.526,95%CI:2.001-3.125,P<0.001),Ann Arbor stages III-IV(HR=5.021,95%CI:4.125-5.998,P<

关 键 词：MYC B细胞淋巴瘤-2 弥漫大B细胞淋巴瘤 模型 美国国家综合癌症网络国际预后指数 

分 类 号：R733.1[医药卫生—肿瘤]