基于SEER数据库分析原发中枢神经系统弥漫大B细胞淋巴瘤患者的预后影响因素  

Prognostic factors for patients with primary central nervous system diffuse large B-cell lymphoma:an analysis based on the SEER database

作　　者：李卓然 徐志秀 李青[2] 毛晓娜 LI Zhuo-ran;XU Zhi-xiu;LI Qing;MAO Xiao-na(Department of Medical Oncology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan,China)

机构地区：[1]新乡医学院第一附属医院肿瘤内科,河南卫辉453100 [2]新乡医学院第一附属医院神经内科,河南卫辉453100

出　　处：《广东医学》2024年第10期1319-1325,共7页Guangdong Medical Journal

基　　金：河南省科技攻关计划项目联合共建项目(LHGJ2020052)。

摘　　要：目的探讨原发中枢神经系统弥漫大B细胞淋巴瘤患者的预后影响因素。方法从美国国立癌症研究所的检测、流行病学、结果数据库(SEER)选择2000—2020年17个研究中心确诊的原发中枢神经系统弥漫大B细胞淋巴瘤患者。采用Log-rank检验和COX回归模型,确定影响原发中枢神经系统弥漫性大B细胞淋巴瘤患者总生存(overall survival,OS)的独立预后因素。结果共纳入3550例患者,Log-rank检验分析显示,不同年龄组、不同受累部位、不同手术方式、是否放疗、是否化疗、是否化疗联合放疗、是否化疗联合手术、是否三种治疗方案联合的患者OS差异有统计学意义(P<0.001,P<0.001,P<0.001,P<0.001,P<0.001,P=0.001,P<0.001,P<0.001)。COX多因素回归模型分析显示,60~69岁年龄组和≥70岁年龄组的患者相对于<60岁年龄组的患者对OS的影响差异有统计学意义(HR=1.600,95%CI:1.447~1.769,P<0.001;HR=2.317,95%CI:2.110~2.544,P<0.001);多发部位受累的患者相对于幕上受累患者对OS的影响差异有统计学意义(HR=1.227,95%CI:1.083~1.390,P=0.001);部分肿瘤切除和完全肿瘤切除的患者相对于未接受手术的患者对OS的影响差异有统计学意义(HR=0.794,95%CI:0.731~0.862,P<0.001;HR=0.829,95%CI:0.716~0.959,P=0.012);化疗患者相对于无化疗患者对OS的影响差异有统计学意义(HR=0.455,95%CI:0.417~0.496,P<0.001)。结论≥60岁年龄组、多发部位是原发中枢神经系统弥漫性大B细胞淋巴瘤患者的预后的独立危险因素,化疗、部分肿瘤切除和完全肿瘤切除是原发中枢神经系统弥漫性大B细胞淋巴瘤患者的预后的独立保护因素。Objective To investigate the prognostic factors affecting patients with primary central nervous system diffuse large B-cell lymphoma(PCNS-DLBCL).Methods Data were extracted from the Surveillance,Epidemiology,and End Results(SEER)database,selecting patients diagnosed with PCNS-DLBCL from 17 research centers between 2000 and 2020.The log-rank test and Cox regression model were used to identify independent prognostic factors influencing overall survival(OS)in these patients.Results A total of 3550 patients were included in the study.Log-rank test analysis revealed statistically significant differences in OS among patients in different age groups,with different affected sites,surgical approaches,whether they received radiotherapy,chemotherapy,combined chemoradiotherapy,or a combination of surgery,chemotherapy,and radiotherapy(P<0.001,P<0.001,P<0.001,P<0.001,P<0.001,P=0.001,P<0.001,P<0.001).Cox multivariate regression analysis indicated that patients aged 60-69 and those≥70 had significantly different OS compared to patients<60 years old(HR=1.600,95%CI:1.447-1.769,P<0.001;HR=2.317,95%CI:2.110-2.544,P<0.001).Patients with multiple lesion involvement had a significantly different OS compared to those with supratentorial lesions(HR=1.227,95%CI:1.083-1.390,P=0.001).Partial tumor resection and complete tumor resection were significant protective factors for OS compared to no surgery(HR=0.794,95%CI:0.731-0.862,P<0.001;HR=0.829,95%CI:0.716-0.959,P=0.012).Chemotherapy was also a significant protective factor for OS compared to no chemotherapy(HR=0.455,95%CI:0.417-0.496,P<0.001).Conclusion Being≥60 years old and having multiple lesion sites are independent risk factors for poor prognosis in patients with PCNS-DLBCL,whereas chemotherapy,partial tumor resection,and complete tumor resection are independent protective factors for better prognosis in these patients.

关 键 词：原发中枢神经系统淋巴瘤 弥漫性大B细胞 生存时间 预后因素 

分 类 号：R733.4[医药卫生—肿瘤] R739.41[医药卫生—临床医学]