简化老年综合评估在老年弥漫大B细胞淋巴瘤中应用的多中心回顾性临床研究  

A multicenter retrospective clinical study of a simplified comprehensive geriatric assessment system in elderly patients with diffuse large B-cell lymphoma

作　　者：冷加燕[1,2] 蔡翊鸿 葛雪萍 赵楠平[4] 苏倩倩 贾祝霞 钱军[1] 李炳宗[4] 华海应[5] 卢旭章 朱华渊 李建勇[2] 施文瑜[3] Leng Jiayan;Cai Yihong;Ge Xueping;Zhao Nanping;Su Qianqian;Jia Zhuxia;Qian Jun;Li Bingzong;Hua Haiying;Lu Xuzhang;Zhu Huayuan;Li Jianyong;Shi Wenyu(Department of Hematology,Affiliated People's Hospital of Jiangsu University,Zhenjiang 212002,China;Department of Hematology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Oncology,Affiliated Hospital of Nantong University,Nantong 226001,China;Department of Hematology,the Second Affiliated Hospital of Soochow University,Suzhou 215000,China;Department of Hematology,the Affiliated Hospital of Jiangnan University,Wuxi 214122,China;Department of Hematology,Changzhou No.2 People's Hospital,Changzhou 213003,China)

机构地区：[1]江苏大学附属人民医院血液科,镇江212002 [2]南京医科大学第一附属医院血液科,南京210029 [3]南通大学附属医院肿瘤科,南通226001 [4]苏州大学附属第二医院血液科,苏州215000 [5]江南大学附属医院血液科,无锡214122 [6]常州市第二人民医院血液科,常州213003

出　　处：《中华血液学杂志》2025年第2期126-133,共8页Chinese Journal of Hematology

基　　金：江苏省研究型医院发展基金课题(YJXYY202204-XKB17);2022年度南通市基础科学研究和社会民生科技计划项目(MS22022111);南通市"十四五"科教强卫工程重点项目,肿瘤学临床医学中心(NTYXZX18);镇江市血液病临床研究中心(SS2018009);镇江市第一人民医院院级科研基金(YP2023003);白求恩·肿瘤临床研究计划项目(BCF-XD-ZL-20220118-001)。

摘　　要：目的评价简化老年综合评估(sGA)在老年弥漫大B细胞淋巴瘤(DLBCL)患者中的预测价值。方法回顾性分析2018年1月至2022年12月在江苏省内6家医院就诊的年龄≥60岁的初诊DLBCL患者219例,分析sGA评分与临床特征、疗效和预后的关系。结果219例患者的中位年龄68(60~87)岁。根据sGA评分标准,将老年DLBCL患者分为适合组、不适合组和脆弱组,分别为101例(46.1%)、103例(47.0%)和15例(6.8%)。接受化疗后发生血液学不良反应最常见,三组的>2级血液学不良反应发生率相似(47.5%、41.7%和46.7%,χ^(2)=0.712,P=0.700)。脆弱组患者的>2级胃肠道、肺不良反应及感染发生率高于适合组和不适合组,但差异无统计学意义(均P>0.05)。适合组、不适合组和脆弱组的缓解率分别为74.3%、46.6%和20.0%(χ^(2)=25.249,P<0.001),疾病进展率分别为5.9%、11.7%和26.7%(χ^(2)=6.763,P<0.05),2年总生存率分别为92.1%(95%CI 86.6%~97.9%)、77.6%(95%CI 69.5%~86.6%)、70.1%(95%CI 49.4%~99.6%)(P<0.05),2年无进展生存率分别为76.8%(95%CI 67.0%~84.8%)、69.7%(95%CI 61.8%~82.0%)、65.7%(95%CI 53.3%~100%),差异无统计学意义(P=0.399)。结论sGA可有效预测老年DLBCL的治疗相关不良反应、疗效、疾病进展及长期生存。ObjectiveTo evaluate the predictive value of simplified geriatric assessment(sGA)in elderly Chinese patients diagnosed with diffuse large B-cell lymphoma(DLBCL).MethodsIt retrospectively analyzed the relationships of sGA with the clinical characteristics,outcome,and prognosis of 219 patients aged≥60 years who were newly diagnosed with DLBCL at six hospitals in Jiangsu province between January 2018 and December 2022.ResultsThe median age of 219 patients was 68 years(60-87 years).According to the sGA system criteria,101(46.1%),103(47.0%),and 15(6.8%)elderly patients with DLBCL were categorized as fit,unfit,and frail,respectively.The most common adverse reactions after chemotherapy were hematologic,and the incidence of grade>2 hematologic adverse reactions was similar among the three groups(47.5%vs 41.7%vs 46.7%,respectively;χ^(2)=0.712,P=0.700).Compared with the fit and unfit groups,the frail group showed tendencies toward for higher proportions of grade>2 gastrointestinal,pulmonary,and infectious adverse reactions(P>0.05 for all).The fit,unfit,and frail groups had respective remission rates of 74.3%,46.6%,and 20.0%(χ^(2)=25.249,P<0.001);disease progression rates of 5.9%,11.7%,and 26.7%(χ^(2)=6.763,P<0.05);2-year overall survival rates of 92.1%(95%CI 86.6%to 97.9%),77.6%(95%CI 69.5%to 86.6%),and 70.1%(95%CI 49.4%to 99.6%)(P<0.05);and 2-year progression-free survival rates of 76.8%(95%CI 67.0%to 84.8%),69.7%(95%CI 61.8%to 82.0%),and 65.7%(95%CI 53.3%to 100%)(P=0.399).ConclusionsGA can effectively predict treatment adverse effects and efficacy,disease progression,and long-term survival in elderly DLBCL.

关 键 词：淋巴瘤 B细胞 简化 老年综合评估 生存分析 

分 类 号：R733.1[医药卫生—肿瘤]