CAJ | 학술논문

目的:分析非霍奇金淋巴瘤(NHL)的预后相关因素,探讨NHL患者入院时外周血淋巴细胞绝时计数的预后价值.方法:回顾性分析2000年1月至2008年1月间108例非霍奇金淋巴瘤患者的临床特征,结合随访资料,应用SPSS14.0软件进行统计分析,采用Kaplan-Meier法对生存概率进行评估,进一步采用Cox回归模型对单因素分析中有统计学意义的参数进行多因素分析.结果:108例非霉奇金淋巴瘤患者中,男女比例约为1.5:1,中位年龄48岁.治疗前,61.1%的患者为Ann ArborⅠ～Ⅱ期,ECOG体力状态(performance status)评分0～1的患者约占总数的93%,乳酸脱氢酶升高见于19.2%的患者,80.6%的患者属于IPI低危组.入院时外周血淋巴细胞绝对计数减少(ALC≤1×109/L)见于35.2%的患者,29.6%的患者有贫血(Hb≤110g/L),26.9%的患者伴有B症状.ALC＞1×10~9/L患者70例.平均Hb为129.2±17.5g/L,而ALC≤1×10~9/L患者38例,平均Hb为98.1±20.6g/L(P<0.05).全组患者中位随访时间2年,中住生存时间2.3年,2年和5年的总生存率分别为73.2%和39.6%.单因素生存分析显示,ALC≤1×10~9/L、Hb≤110g/L、B症状及国际预后指数(IPI)≥2是NHL的不良预后因素.多因素分析显示,ALC≤1×10~9/L、B症状及IPI≥2是NHL的独立不良预后因素.结论:外周血淋巴细胞绝对计数及B症状是独立于国际预后指数之外的非霍奇金淋巴瘤预后指标.临床上,根据IPI及简单的临床参数ALC和B症状判断NHL预后,对实施个体化治疗可能具有更大实用价值.
목적:분석비곽기금림파류(NHL)적예후상관인소,탐토NHL환자입원시외주혈림파세포절시계수적예후개치.방법:회고성분석2000년1월지2008년1월간108례비곽기금림파류환자적림상특정,결합수방자료,응용SPSS14.0연건진행통계분석,채용Kaplan-Meier법대생존개솔진행평고,진일보채용Cox회귀모형대단인소분석중유통계학의의적삼수진행다인소분석.결과:108례비매기금림파류환자중,남녀비례약위1.5:1,중위년령48세.치료전,61.1%적환자위Ann ArborⅠ～Ⅱ기,ECOG체력상태(performance status)평분0～1적환자약점총수적93%,유산탈경매승고견우19.2%적환자,80.6%적환자속우IPI저위조.입원시외주혈림파세포절대계수감소(ALC≤1×109/L)견우35.2%적환자,29.6%적환자유빈혈(Hb≤110g/L),26.9%적환자반유B증상.ALC＞1×10~9/L환자70례.평균Hb위129.2±17.5g/L,이ALC≤1×10~9/L환자38례,평균Hb위98.1±20.6g/L(P<0.05).전조환자중위수방시간2년,중주생존시간2.3년,2년화5년적총생존솔분별위73.2%화39.6%.단인소생존분석현시,ALC≤1×10~9/L、Hb≤110g/L、B증상급국제예후지수(IPI)≥2시NHL적불량예후인소.다인소분석현시,ALC≤1×10~9/L、B증상급IPI≥2시NHL적독립불량예후인소.결론:외주혈림파세포절대계수급B증상시독립우국제예후지수지외적비곽기금림파류예후지표.림상상,근거IPI급간단적림상삼수ALC화B증상판단NHL예후,대실시개체화치료가능구유경대실용개치.
Objective: To analyze the prognostic factors of non-Hodgkin's lymphoma(NHL)and to investigate the prognostic value of peripheral blood absolute lymphocyte count(ALC)at admission for patients with NHL. Methods: Clinical features and follow-up data of 108 patients with pathologically confirmed NHL seen in our hospital between January 2000 and January 2008 were reviewed.SPSS14.0 package was used for statistical analysis.Kaplan-Meier was applied to assess the survival probability.All parameters statistically significant concluded by univariate analysis were then computed as co-variates for multivariate analysis with Cox regression model. Results: The ratio of males to females was approximately 1.5:1.The median age of patients was 48 years.Before treatment.the Ann Arbor clinical classification showed that 61.1% of the cases were of stage Ⅰ and Ⅱ.Approximately 93%of the patients had ECOG performance status(PS)score of 0-1 and 19.2%of the cases had elevated serum lactate dehydrogenase(LDH).According to intemational prognosis index score.80.6%of the patients were in a low risk group.At admission，35.2%of the cases had ALC≤1×10~9/L.Hemoglobin (Hb)≤110g/L and B symptoms were seen in 29.6%and 26.9%of the patients.The mean Hb was 129.2±17.5g/L in cases with ALC>1×10~9/L(n=70)and 98.1±20.6g/L in cases with ALC≤1×10~9/L(n=38),with a statistically significant difference between the two groups(P<0.05).With a median follow-up duration of 2 years，the median overall survival(OS)time was 2.3 years for all patients.The 2-year and 5-year OS rates were 73.2%and 39.6%，respectively.ALC≤1×10~9/L,Hb≤110g/L,B symptoms and intemational prognostic index(IPI)≥2 were statistically significant unfavorable prognostic factors for NHL revealed by univariate analysis.Multivariate analysis showed that ALC≤1×10~9/L,B symptoms and IPI ≥2 were statistically significant unfavorable prognostic factors for NHL. Conclusion: ALC and B symptoms may be prognostic factors independent of IPI for NHL.Evaluation of the prognosis with IPI,ALC，and B symptoms is of clinical value for individualized therapy of NHL patients.