单中心85例初治滤泡淋巴瘤临床特征、预后分析及老年综合评估  

The clinical features, survival analysis, and geriatric assessment of 85 patients with follicularlymphoma: a single-center study

作　　者：尹晶晶[1] 钱龙 白洁菲[1] 冯茹[1] 李江涛[1] 王婷[1] 张春丽[1] 刘辉[1] Yin Jingjing;Qian Long;Bai Jiefei;Feng Ru;Li Jiangtao;Wang Ting;Zhang Chunli;Liu Hui(Department of Hematology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Science,Beijing 100730,China)

机构地区：[1]北京医院血液科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《中华血液学杂志》2024年第3期233-241,共9页Chinese Journal of Hematology

基　　金：中央高水平医院临床科研业务费(BJ-2022-127);北京市自然科学基金(7232137);中国医学科学院医学与健康科技创新工程项目(2021-I2M-C&T-A-020);北京市卫生健康科技成果和适宜技术推广项目(BHTPP2022094)。

摘　　要：目的探讨初治滤泡淋巴瘤(FL)患者的临床特征与预后,以及老年综合评估(comprehensive geriatric assessment,CGA)对国内年龄≥60岁FL患者的预后价值。方法收集2011年8月至2022年6月北京医院血液科收治的85例初诊FL患者临床资料及预后情况。统计分析患者临床特征、实验室指标、治疗疗效、生存及预后因素,使用多种老年评估工具对患者预后分层。结果①FL患者多为中老年起病,中位发病年龄59(20~87)岁,其中年龄≥60岁者41例(48.2%),男女比例为1∶1.36。77.6%的患者诊断时Ann Arbor分期为Ⅲ~Ⅳ期,伴有B症状17例(20.0%),骨髓侵犯最常见(34.1%)。②71例患者接受一线系统化疗和(或)免疫治疗,可评估疗效的68例患者中总缓解率为86.8%,完全缓解率为47.1%。其中17例(23.9%)患者在治疗2年内病情进展或复发,共计10例(14.1%)患者死亡。③R-CHOP治疗组生存分析示:中位随访52.9(10.2~138.8)个月,3年无进展生存(PFS)率及总生存(OS)率分别为85.2%和95.9%,5年PFS率及OS率为72.8%和88.8%。单因素分析年龄≥60岁(HR=3.430,95%CI 1.256~9.371,P=0.016)、B症状(HR=5.030,95%CI 1.903~13.294,P=0.001)、预后营养指数(PNI)<45.25(HR=3.478,95%CI 1.299~9.310,P=0.013)、FL国际预后指数(FLIPI)高危(HR=2.918,95%CI 1.074~7.928,P=0.036)、PRIMA预后指数(PRIMA-PI)高危(HR=2.745,95%CI 1.057~7.129,P=0.038)是PFS的不良预后因素。POD24(HR=9.160,95%CI 1.202~69.830,P=0.033)是OS的不良预后因素。多因素分析中年龄≥60岁(HR=3.002,95%CI 1.014~8.889,P=0.047),B症状(HR=3.810,95%CI 1.052~13.801,P=0.042)能独立预测PFS,未发现影响OS的独立预测因素。结论FL多为中老年女性患者。年龄、B症状、PNI、FLIPI、PRIMA-PI、POD24是影响FL患者PFS和OS的重要因素。CGA对预测老年FL预后及指导治疗均可能具有一定价值。Objective To retrospectively analyze the clinical characteristics and prognosis of 85 newly diagnosed patients with follicular lymphoma(FL),as well as the prognostic value of comprehensive geriatric assessment(CGA)in patients with FL aged≥60 years old.Methods The clinical data and prognosis of 85 newly diagnosed FL patients admitted from August 2011 to June 2022 were collected.The clinical features,laboratory indicators,therapeutic efficacy,survival and prognostic factors of patients were statistically analyzed,and the prognosis of patients was stratified using various geriatric assessment tools.Results years,including①The patients with FL were mostly middle-aged and older,with a median age of 59(20-87)41 patients(48.2%)aged≥60 years.The ratio of male to female was 1∶1.36.Overall,77.6% of the patients were diagnosed with Ann Arbor stage Ⅲ - Ⅳ, and 17 cases (20.0%) wereaccompanied by B symptoms. Bone marrow involvement was the most common(34.1%). ②Overall, 71patients received immunochemotherapy. The overall response rate was 86.6%, and the complete recoveryrate was 47.1% of 68 evaluated patients. Disease progression or relapse in the first 2 years was observed in23.9% of the patient. Overall, 14.1% of the patients died during follow-up. ③Of the 56R- CHOP- like therapies, the 3- year and 5- year progression- free survival(PFSpatients receiving)rates were 85.2% and72.8% , respectively, and the 3- year and 5- year overall survival(OS)rates were 95.9% and 88.8% ,respectively. The univariate analysis showed that age ≥60 years old(HR=3.430, 95% CI 1.256-9.371, P=0.016), B symptoms(HR=5.030, 95% CI 1.903-13.294, P=0.016), Prognostic Nutritional Index(PNI)<45.25(HR=3.478, 95% CI 1.299-9.310, P=(FLIPI)high-risk(HR=2.918, 95%0.013), Follicular Lymphoma International Prognostic IndexCI 1.074-7.928, P=0.036), and PRIMA-prognostic index(PRIMA-PI)high-risk(HR=2.745, 95% CI 1.057-7.129, P=0.038)significantly predicted PFS. Moreover, age60 years old and B symptoms were independent risk factors for PFS. Progressi

关 键 词：淋巴瘤 滤泡性 生存分析 老年综合评估 

分 类 号：R73[医药卫生—肿瘤]