中国医药导报
中國醫藥導報
중국의약도보
CHINA MEDICAL HERALD
2014年
32期
51-54,59
,共5页
杨朋%李艳%蔡存伟%邹志英
楊朋%李豔%蔡存偉%鄒誌英
양붕%리염%채존위%추지영
弥漫大B淋巴瘤%老年人%预后%生存分析
瀰漫大B淋巴瘤%老年人%預後%生存分析
미만대B림파류%노년인%예후%생존분석
Diffuse large B-cell lymphoma%The old patient%Prognosis%Survival analysis
目的：探讨老年弥漫大B细胞淋巴瘤(DLBCL)的预后相关因素。方法回顾性分析2007年8月~2012年7月沈阳市第四人民医院收治的56例老年DLBCL患者的年龄、Ann-Arbor分期、B症状、体能状态ECOG评分、骨髓浸润、最大肿块直径、乳酸脱氢酶(LDH)、β2-微球蛋白(β2-MG)、国际预后评分指数(IPI)、细胞来源、Ki-67指数、治疗方案等临床资料，研究上述指标与预后的相关性。结果56例患者中位生存时间为25.2个月，2年总生存(OS)率为49.7%，总完全缓解(CR)率为50.0%；CHOP方案组CR 13例(40.6%)，利妥昔单抗(Rituximab)联合CHOP(R-CHOP)方案组CR 15例(62.5%)，R-CHOP组的总有效率及CR率均优于CHOP组(均P<0.05)。单因素分析显示：年龄≥80岁、Ann Arbor分期、骨髓受累、ECOG评分、最大肿块直径≥10 cm、IPI、治疗前LDH值、免疫分型、治疗方案均与预后有关(P<0.05或P<0.01)；COX回归多因素分析表明，IPI、骨髓浸润、免疫分型、化疗方案是影响老年DLBCL患者预后的独立危险因素(P<0.05或P<0.01)。结论老年DLBCL具有肿瘤分期晚、合并疾病多、疗效差、生存期短等特点；IPI、骨髓浸润、免疫分型、化疗方案是老年DLBCL预后的独立危险因素；R-CHOP方案能提高疗效及改善预后。
目的：探討老年瀰漫大B細胞淋巴瘤(DLBCL)的預後相關因素。方法迴顧性分析2007年8月~2012年7月瀋暘市第四人民醫院收治的56例老年DLBCL患者的年齡、Ann-Arbor分期、B癥狀、體能狀態ECOG評分、骨髓浸潤、最大腫塊直徑、乳痠脫氫酶(LDH)、β2-微毬蛋白(β2-MG)、國際預後評分指數(IPI)、細胞來源、Ki-67指數、治療方案等臨床資料，研究上述指標與預後的相關性。結果56例患者中位生存時間為25.2箇月，2年總生存(OS)率為49.7%，總完全緩解(CR)率為50.0%；CHOP方案組CR 13例(40.6%)，利妥昔單抗(Rituximab)聯閤CHOP(R-CHOP)方案組CR 15例(62.5%)，R-CHOP組的總有效率及CR率均優于CHOP組(均P<0.05)。單因素分析顯示：年齡≥80歲、Ann Arbor分期、骨髓受纍、ECOG評分、最大腫塊直徑≥10 cm、IPI、治療前LDH值、免疫分型、治療方案均與預後有關(P<0.05或P<0.01)；COX迴歸多因素分析錶明，IPI、骨髓浸潤、免疫分型、化療方案是影響老年DLBCL患者預後的獨立危險因素(P<0.05或P<0.01)。結論老年DLBCL具有腫瘤分期晚、閤併疾病多、療效差、生存期短等特點；IPI、骨髓浸潤、免疫分型、化療方案是老年DLBCL預後的獨立危險因素；R-CHOP方案能提高療效及改善預後。
목적：탐토노년미만대B세포림파류(DLBCL)적예후상관인소。방법회고성분석2007년8월~2012년7월침양시제사인민의원수치적56례노년DLBCL환자적년령、Ann-Arbor분기、B증상、체능상태ECOG평분、골수침윤、최대종괴직경、유산탈경매(LDH)、β2-미구단백(β2-MG)、국제예후평분지수(IPI)、세포래원、Ki-67지수、치료방안등림상자료，연구상술지표여예후적상관성。결과56례환자중위생존시간위25.2개월，2년총생존(OS)솔위49.7%，총완전완해(CR)솔위50.0%；CHOP방안조CR 13례(40.6%)，리타석단항(Rituximab)연합CHOP(R-CHOP)방안조CR 15례(62.5%)，R-CHOP조적총유효솔급CR솔균우우CHOP조(균P<0.05)。단인소분석현시：년령≥80세、Ann Arbor분기、골수수루、ECOG평분、최대종괴직경≥10 cm、IPI、치료전LDH치、면역분형、치료방안균여예후유관(P<0.05혹P<0.01)；COX회귀다인소분석표명，IPI、골수침윤、면역분형、화료방안시영향노년DLBCL환자예후적독립위험인소(P<0.05혹P<0.01)。결론노년DLBCL구유종류분기만、합병질병다、료효차、생존기단등특점；IPI、골수침윤、면역분형、화료방안시노년DLBCL예후적독립위험인소；R-CHOP방안능제고료효급개선예후。
Objective To study the prognostic factors of elderly patients with diffuse large B-cell lymphoma (DLBCL). Methods Clinical data of 56 cases of DLBCL patients admitted by the Fourth People's Hospital of Shenyang City from August 2007 to July 2012 were retrospectively analyzed, including the age, Ann-Arbor staging, B symptoms, ECOG score of performance status, bone marrow invasion, the maximum diameter of tumor, LDH,β2-MG, IPI, cell source, Ki-67 index, therapeutic regimen. The correlation between these indexes and prognosis was analyzed. Results For the 56 patients, the median survival time was 25.2 months, and the overall survival (OS) rate was 49.7% in the two years, total complete remission (CR) rate was 50.0%. 13 cases (40.6%) with CR were in CHOP scheme group, 15 cases (62.5%) with CR were in R-CHOP scheme group. The general rate of effectiveness and CR of R-CHOP were higher than that of CHOP group (all P<0.05). Single factor analysis showed that age≥80, Ann Arbor staging, bone marrow involvement, ECOG score, the maximum diameter of tumor ≥10 cm, IPI score, value of LDH before treatment, immunophenotyping, therapeutic regimen were all related with prognosis (P< 0.05 or P<0.01). COX regression multiple-factor analysis in-dicated that IPI, bone marrow invasion, immunophenotyping and chemotherapy were separate hazardous factors which affected the prognosis of the old patients with DLBCL (P<0.05 or P<0.01). Conclusion The DLBCL for the old is char-acterized in late tumor staging, various combined diseases, poor curative effect, short survival time, etc. IPI, bone mar-row invasion, immunophenotyping and chemotherapy are separate hazardous factors which affect the prognosis of the old patients with DLBCL. The R-CHOP scheme will enhance curative effect and improve prognosis.
