发生组织学转化的滤泡淋巴瘤患者临床病理特征分析  

Clinicopathological analysis of follicular lymphoma patients with histological transformation

作　　者：滑人杰 陈清江[1] 张旭东[1] 段豫凯 乔泓涵 张思珺 宗斐扬 HUA Renjie;CHEN Qingjiang;ZHANG Xudong;DUAN Yukai;QIAO Honghan;ZHANG Sijun;ZONG Feiyang(Department of Medical Oncology,the First Affiliated Hospital of Zhengzhou University,Henan Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肿瘤内科,河南郑州450052

出　　处：《现代肿瘤医学》2024年第8期1465-1469,共5页Journal of Modern Oncology

基　　金：国家自然科学基金面上项目(编号:82070210);河南省医学科技攻关重大项目(编号:SBGJ202001008)。

摘　　要：目的:探讨发生组织学转化(histological transformation,HT)的滤泡淋巴瘤(follicular lymphoma,FL)患者的临床表现、组织病理学特征、不同治疗方案疗效及预后。方法:选取我院2018年12月至2022年10月收治的26例发生组织学转化的滤泡淋巴瘤患者,回顾性分析患者的临床特征、病理特征、治疗方案、疗效及生存状况。结果:26例患者,中位年龄57(43~97)岁,其中25例转化为弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL),低级别转化2例,高级别转化19例,1例转化为B淋巴母细胞白血病/淋巴瘤(B-lymphoblastic leukemia/lymphoma,B-LBL);11例出现结外侵犯,8例出现骨髓侵犯;初步诊断时发生转化的患者17例,转化后的疗效5例达到CR,8例达到PR,化疗之后发生转化的患者9例,转化后疗效4例达到PR,两组ORR分别为76.5%和44.4%,两组ORR差异无统计学意义(P=0.194)。全部患者中位随访时间22个月,中位PFS未达到(3~45个月)和中位OS未达到(5~45个月),2年OS率和PFS率分别为80.7%和64.8%。单因素分析结果显示:ECOG评分(P=0.040)、Ki-67(P=0.005)是影响患者PFS的因素。Ann Arbor分期(P=0.014)、FLIPI-1评分(P=0.008)是影响患者OS的因素。多因素分析结果显示,Ki-67(P=0.028)是影响患者PFS独立的预后因素。结论:FL患者发生组织学转化后预后不良,ECOG评分≥2分、Ki-67≥70%的患者PFS差,Ann Arbor分期Ⅲ-Ⅳ期、FLIPI-1评分>2分的患者OS差,Ki-67是影响患者PFS的独立预后因素。Objective:To investigate the clinical manifestations,histopathological features,therapeutic efficacy and prognosis of follicular lymphoma(FL)patients with histological transformation(HT).Methods:A total of 26 FL patients with histological transformation treated at our hospital from December 2018 to October 2022 were selected.The clinical features,pathological features,survival status,treatment and efficacy of the patients were collected and analyzed retrospectively.Results:Of the 26 patients with a median age of 57(43~97)years,25 patients transformed to diffuse large B-cell lymphoma,including 2 low-grade,19 high-grade,and 1 patient transformed to B-lymphoblastic leukemia/lymphoma.Extranodal invasion occurred in 11 cases and bone marrow invasion in 8 cases.There were 17 patients who underwent transformation at the time of initial diagnosis,5 patients achieved CR and 8 patients achieved PR after transformation.9 patients underwent transformation after chemotherapy,4 patients achieved PR after transformation.The ORR of the two groups was 76.5% and 44.4%,there was no statistically difference between the two groups(P=0.194).The median follow-up time of all patients was 22 months,and the median PFS(3~45 months)and OS(5~45)months were not achieved.The 2-year OS and PFS rates were 80.7%and 64.8%,respectively.The results of univariate analysis showed that ECOG score(P=0.040)and Ki-67(P=0.005)were the factors affecting patients'PFS.Ann Arbor stage(P=0.014)and FLIP-1 score(P=0.008)were the factors that affected patients'OS.Multivariate analysis showed that Ki-67(P=0.028)was an independent prognostic factor affecting patients PFS.Conclusion:The prognosis of FL patients with histological transformation is poor.Patients with ECOG score≥2 or Ki-67≥70% have poor PFS,and patients with Ann Arbor stage Ⅲ to Ⅳ or FLIP-1 score>2 have poor OS.Ki-67 was an independent prognostic factor affecting patients PFS.

关 键 词：滤泡淋巴瘤 组织学转化 弥漫大B细胞淋巴瘤 B淋巴母细胞白血病/淋巴瘤 预后 

分 类 号：R733.4[医药卫生—肿瘤]