营养控制状态评分对晚期弥漫大B细胞淋巴瘤患者预后的预测价值  

Predictive value of controlling nutritional status score in the prognosis of patients with advanced diffuse large B-cell lymphoma

作　　者：单慧蓉 陈玺丞 张颢[3] 苗雨青 王飞 史玉叶[6] 王玲[7] 叶静静[8] 沈子园 桑威 葛洪峰[10] Shan Huirong;Chen Xicheng;Zhang Hao;Miao Yuqing;Wang Fei;Shi Yuye;Wang Ling;Ye Jingjing;Shen Ziyuan;Sang Wei;Ge Hongfeng(Department of Hematology,Shuyang County Hospital of Traditional Chinese Medicine,Suqian 223600,China;Department of Hematology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;Department of Hematology,the Affiliated Hospital of Jining Medical University,Jining 272000,China;Department of Hematology,Yancheng First People's Hospital,Yancheng 224001,China;Department of Hematology,the First People's Hospital of Changzhou,Changzhou 213003,China;Department of Hematology,the First People's Hospital of Huai'an,Huai'an 223000,China;Department of Hematology,Tai'an Central Hospital,Tai'an 271000,China;Department of Hematology,Qilu Hospital of Shandong University,Jinan 250012,China;School of Public Health,Anhui Medical University,Hefei 230032,China;Department of Hematology,Bozhou People's Hospital,Bozhou 236800,China)

机构地区：[1]宿迁市沭阳县中医院血液科,宿迁223600 [2]徐州医科大学附属医院血液科,徐州221002 [3]济宁医学院附属医院血液科,济宁272000 [4]盐城市第一人民医院血液科,盐城224001 [5]常州市第一人民医院血液科,常州213003 [6]淮安市第一人民医院血液科,淮安223000 [7]泰安市中心医院血液科,泰安271000 [8]山东大学齐鲁医院血液科,济南250012 [9]安徽医科大学公共卫生学院,合肥230032 [10]亳州市人民医院血液科,亳州236800

出　　处：《白血病．淋巴瘤》2024年第2期104-109,共6页Journal of Leukemia & Lymphoma

基　　金：江苏省自然科学基金(BK20171181);江苏省科技厅社会发展重点项目(BE2019638);江苏省青年医学重点人才(QNRC2016791)。

摘　　要：目的探讨营养控制状态(CONUT)评分对晚期弥漫大B细胞淋巴瘤(DLBCL)患者预后的预测价值。方法回顾性病例系列研究。回顾性收集2009年10月至2022年1月淮海淋巴瘤协作组中7家医疗中心确诊的654例初诊晚期DLBCL患者的临床资料,所有患者均接受以利妥昔单抗为基础的免疫化疗方案治疗。按照7∶3比例将患者随机分配为训练集(458例)和验证集(196例)。收集患者临床病理资料,根据清蛋白、淋巴细胞计数和总胆固醇计算CONUT评分。根据MaxStat统计量确定CONUT评分的最佳临界值。采用Kaplan-Meier法绘制生存曲线;采用Cox比例风险模型对总生存(OS)的影响因素进行单因素、多因素分析;采用受试者工作特征(ROC)曲线评估CONUT评分分别联合国际预后指数(IPI)、改良国际预后指数(NCCN-IPI)预测OS的效能。结果654例患者中位随访时间为38.1个月(95%CI:35.3~40.9个月),5年OS率为49.2%。根据MaxStat统计量确定CONUT评分的最佳临界值为6分,将患者分为营养状况正常组(CONUT评分≤6分)(489例)和营养状况不良组(CONUT评分>6分)(165例)。多因素分析结果显示,CONUT评分>6分、男性、乳酸脱氢酶>240 U/L、高白细胞计数、低血红蛋白水平、年龄>60岁是晚期DLBCL患者OS的独立危险因素(均P<0.05)。整体晚期DLBCL营养状况不良组患者(CONUT评分>6分)OS较营养状况正常组(CONUT评分≤6分)差(P<0.001);亚组分析结果表明,在ECOG PS评分<2分、IPI低中危险、IPI中高危、NCCN-IPI低中危、NCCN-IPI中高危的患者中,营养状况不良组(CONUT评分>6分)患者OS较营养状况正常组(CONUT评分≤6分)差(均P<0.05)。结论CONUT评分评估晚期DLBCL患者预后具有一定的价值,且CONUT评分联合IPI、NCCN-IPI的预测效能进一步提高。Objective To investigate the predictive value of controlling nutritional status(CONUT)score in the prognosis of patients with advanced diffuse large B-cell lymphoma(DLBCL).Methods A retrospective case series study was performed.The clinical data of 654 patients newly diagnosed with advanced DLBCL diagnosed in 7 medical centers in Huaihai Lymphoma Working Group from October 2009 to January 2022 were retrospectively collected.All the patients received rituximab-based immune chemotherapy regimens.The patients were randomly assigned to the training set(458 cases)and the validation set(196 cases)in a 7:3 ratio.The clinicopathological data of patients were collected,and the CONUT score was calculated based on albumin,lymphocyte count,and total cholesterol.The optimal critical value of CONUT scote was determined by using MaxStat method.Kaplan-Meier method was used to draw survival curves;Cox proportional hazards model was used to make univariate analysis and multivariate analysis on the factors influencing overall survival(OS).The efficacy of CONUT score in combination with the International prognostic index(IPI)and an enhanced IPI(NCCN-IPI)in predicting OS was evaluated by using receiver operating characteristic(ROC)curves.Results The median follow-up time of 654 patients was 38.1 months(95%CI:35.3 months-40.9 months),and the 5-year OS rate was 49.2%.According to the MaxStat method,the optimal critical value for CONUT score was determined to be 6 points.All the patients were classified into the normal nutritional status group(CONUT score≤6 points,489 cases)and the poor nutritional status group(CONUT score>6 points,165 cases).The results of the multivariate analysis showed that CONUT score>6 points,male,lactate dehydrogenase>240 U/L,high white blood cell count,low hemoglobin level and age>60 years were independent risk factors for OS of patients with advanced DLBCL(all P<0.05).Patients in the poor nutritional status group(CONUT score>6 points)had worse OS compared with that in the normal nutritional status group in th

关 键 词：淋巴瘤 大B细胞 弥漫性 营养评价 预后 

分 类 号：R733.1[医药卫生—肿瘤]