CAJ | 학술논문

目的探讨慢性淋巴细胞白血病(CLL)患者预后的主要影响因素.方法回顾性分析2000年至2007年就诊于中国医学科学院血液病医院并获得有效随访的203例CLL患者临床资料,收集可能影响预后的因素,以Kaplan-Meier法绘制生存曲线,用Log-rank检验进行单因素分析,运用COX回归模型评估独立预后因素.结果全组CLL患者中位随访时间为48.0(3.0～156.0)个月,5年总体生存(OS)率为(87.3±2.4)%,10年OS率为(77.4 ±3.3)%,死亡48例(23.6%).单因素分析显示临床分期为晚期、有B症状、结外器官受累、受累淋巴区≥3个、肝脏肿大、Hb<100 g/L、BPC<100 ×109/L、外周血淋巴细胞计数(ALC)>50 ×109/L、形态学表现为混合细胞型、病程中出现分期进展、对治疗无反应、并发感染、并发第二肿瘤或类型转化为不良预后因素.多因素分析显示受累淋巴区≥3个和彤态学表现为混合细胞型为独立的不良预后因素,根据这两项结果重新分组,低危、中危、高危组患者5年OS率分别为(89.8±3.5)%、(66.4±7.2)%、(15.0±13.8)%.各组间差异均具有统计学意义(P值均<0.05).结论初诊时受累淋巴区数和CLL细胞形态学特征有助于评估CLL患者的预后.
목적 탐토만성림파세포백혈병(CLL)환자예후적주요영향인소.방법 회고성분석2000년지2007년취진우중국의학과학원혈액병의원병획득유효수방적203례CLL환자림상자료,수집가능영향예후적인소,이Kaplan-Meier법회제생존곡선,용Log-rank검험진행단인소분석,운용COX회귀모형평고독립예후인소.결과 전조CLL환자중위수방시간위48.0(3.0～156.0)개월,5년총체생존(OS)솔위(87.3±2.4)%,10년OS솔위(77.4 ±3.3)%,사망48례(23.6%).단인소분석현시림상분기위만기、유B증상、결외기관수루、수루림파구≥3개、간장종대、Hb<100 g/L、BPC<100 ×109/L、외주혈림파세포계수(ALC)>50 ×109/L、형태학표현위혼합세포형、병정중출현분기진전、대치료무반응、병발감염、병발제이종류혹류형전화위불량예후인소.다인소분석현시수루림파구≥3개화동태학표현위혼합세포형위독립적불량예후인소,근거저량항결과중신분조,저위、중위、고위조환자5년OS솔분별위(89.8±3.5)%、(66.4±7.2)%、(15.0±13.8)%.각조간차이균구유통계학의의(P치균<0.05).결론 초진시수루림파구수화CLL세포형태학특정유조우평고CLL환자적예후.
Objective To explore prognostic factors in patients with chronic lymphocytic leukemia (CLL). Methods Two hundred and three CLL patients in our hospital between 2000 to 2007 were retro-spectively reviewed for prognostic factor analysis. Survival was analysed by Kaplan-Meier analysis, univariate analysis by Log-rank test and multivariate analysis by COX regression model. Results With a median follow-up time of 48.0 (3.0 - 156.0) months, the 5-year overall survival (OS) rate was (87.3 ± 2.4) % and 10-year OS rate was (77.4 ± 3.3) %. Forty-eight (23.6%) patients died. Univariate analysis indicated that ad-vanced clinical stage, B symptoms, extranodal involvement, number of lymph node regions involved ≥3, en-larged liver, Hb < 100 g/L, BPC < 100 × 109/L, absolute lymphocyte count (ALC) > 50 × 109/L, atypical cell morphology, progression to stage, non-respons to treatment, complicating infections and secondary cancer or disease transformation were associated with poor prognosis. And on multivariate analysis, lymph node re-gion involvod≥3 and atypical cell morphology were independent poor prognostic factors. Based on the two in-dependent poor prognostic factors, three risk groups were defined: low- (0 factor), intermediate-(one factor) and high-(two factors) groups. The 5 year OS rates were (89.8 ± 3.5) % , (66.4 ～ 7.2) % and (15.0 ±13.8)%, respectively, and the difference between them was statistically. Conclusion The number of lymph node region involved and cell morphology are useful for assessing CLL patients prognosis.