POD24的脾边缘区淋巴瘤的临床特征及预后  

Clinical features and prognosis of splenic marginal zone lymphoma with POD24

作　　者：王露 施晴 赵维莅[1] 王黎[1] Wang Lu;Shi Qing;Zhao Weili;Wang Li(Shanghai Institute of Hematology,State Key Laboratory of Genomics and Disease,National Translational Medicine Research Center,Department of Hematology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;Department of Hematology,General Hospital of Taiyuan Iron and Steel(Group)Company Limited(The Sixth Hospital of Shanxi Medical University,The Sixth Clinical Medical College of Shanxi Medical University),Taiyuan 030000,China)

机构地区：[1]上海血液学研究所,组学与疾病国家重点实验室,国家转化医学研究中心,上海交通大学医学院附属瑞金医院血液科,上海200025 [2]太原钢铁(集团)有限公司总医院(山西医科大学第六医院、山西医科大学第六临床医学院)血液科,太原030000

出　　处：《中华血液学杂志》2025年第1期81-87,共7页Chinese Journal of Hematology

摘　　要：目的探讨脾边缘区淋巴瘤(splenic marginal zone lymphoma,SMZL)确诊后24个月内疾病进展(POD24)患者的临床特征、预后及危险因素。方法回顾性分析2009年12月至2022年10月在上海交通大学医学院附属瑞金医院就诊的88例初治SMZL患者的临床资料,根据POD24发生情况分组并进行预后评估及临床特征比较。结果男45例(51.1%),女43例(48.9%),诊断时中位年龄59(24~82)岁。10例(11.4%)发生POD24。POD24组总生存(OS)期和无进展生存(PFS)期短于非POD24组[中位OS期:77(11~159)个月对未达到,P<0.001;中位PFS期:15(4~24)个月对121(24~154)个月,P<0.001]。单因素Cox分析显示,美国东部肿瘤协作组(ECOG)评分≥2分[HR=8.942(95%CI 1.097~72.910),P=0.041]、年龄调整的国际预后指数(aaIPI)评分高危[HR=5.070(95%CI 1.256~20.461),P=0.023]、POD24[HR=14.049(95%CI 3.339~59.107),P<0.001]、发生组织转化[HR=7.819(95%CI 1.952~31.316),P=0.004]、初始治疗后疾病未缓解[HR=6.080(95%CI 1.439~25.690),P=0.014]为SMZL患者OS的影响因素。多因素分析显示,POD24[HR=5.859(95%CI 1.249~27.475),P=0.025]、发生组织转化[HR=5.520(95%CI 1.050~29.009),P=0.044]为OS的独立预后不良因素。单因素Logistic分析显示,ECOG评分≥2分[HR=7.556(95%CI 1.498~38.110),P=0.014]、aaIPI评分高危[HR=5.500(95%CI 1.378~21.945),P=0.016]、发生组织转化[HR=8.000(95%CI 1.759~36.383),P=0.007]、初始治疗后疾病未缓解[HR=9.136(95%CI 2.216~37.675),P=0.002]与POD24的发生相关。多因素分析显示,初始治疗后疾病未缓解[HR=8.253(95%CI 1.681~40.518),P=0.009]为影响POD24的独立危险因素。结论POD24、发生组织转化为影响SMZL患者OS的独立预后不良因素。POD24患者发生组织转化风险高。初始治疗后疾病未缓解为影响POD24患者的独立危险因素。ObjectiveTo investigate the clinical characteristics,prognosis,and risk factors associated with disease progression within 24 months(POD24)after diagnosis in patients with splenic marginal zone lymphoma(SMZL).MethodsClinical data from 88 newly diagnosed SMZL patients treated at Ruijin Hospital,Shanghai Jiaotong University School of Medicine,between December 2009 and October 2022,were retrospectively analyzed.Patients were grouped based on the presence of POD24 for prognostic evaluation and comparison of clinical features.ResultsThere were 45 males(51.1%)and 43 females(48.9%),with a median age of 59(24-82)years at the time of diagnosis.Ten(11.4%)cases occurred POD24.The overall survival(OS)time and progression-free survival(PFS)time in the POD24 group were shorten than non-POD24 group[median OS time:77(11-159)months vs not reached,P<0.001;15(4-24)months vs 121(24-154)months,P<0.001].Univariate Cox analysis showed that Eastern Cooperative Oncology Group(ECOG)score≥2[HR=8.942(95%CI 1.097-72.910),P=0.041],age-adjusted International Prognostic Index(aaIPI)score of high-risk[HR=5.070(95%CI 1.256-20.461),P=0.023],POD24[HR=14.049(95%CI 3.339-59.107),P<0.001],occurrence of tissue transformation[HR=7.819(95%CI 1.952-31.316),P=0.004],and disease unremission status after initial treatment[HR=6.080(95%CI 1.439-25.690),P=0.014]were the influencing factors for OS in SMZL patients.Multivariate analysis showed that POD24[HR=5.859(95%CI 1.249–27.475),P=0.025]and occurrence of tissue transformation[HR=5.520(95%CI 1.050-29.009),P=0.044]were independent prognostic factors affecting OS.Univariate logistic analysis showed that ECOG≥2[HR=7.556(95%CI 1.498-38.110),P=0.014],high risk of aaIPI score[HR=5.500(95%CI 1.378-21.945),P=0.016],occurrence of tissue transformation[HR=8.000(95%CI 1.759-36.383),P=0.007],and disease unremission status after initial treatment[HR=9.136(95%CI 2.216-37.675),P=0.002]were the influencing factors of POD24.Multifactorial analysis showed that disease unremission after initial treatment[HR=8.253(95%CI 1.6

关 键 词：淋巴瘤 B细胞 边缘区 脾肿瘤 24个月内疾病进展 预后 

分 类 号：R733.2[医药卫生—肿瘤]