CAJ | 학술논문

目的探讨老年T/NK细胞淋巴瘤的预后相关因素.方法收集上海交通大学医学院附属瑞金医院12年来收治的62例老年T/NK细胞淋巴瘤患者的临床资料,按Ann Arbor分期、临床状态、结外累及、骨髓浸润状况、LDH水平等指标应用COX回归模型进行预后相关因素的单因素和多因素统计分析.通过IPI或PIT分层系统对T/NK细胞淋巴瘤患者进行危险度分层,不同危险度组患者的总生存时间应用Log-rank检验进行组间比较.结果根据IPI评分分组,低危组(IPI=1)、低中危组(IPI=2)、高中危组(IPI=3)、高危组(IPI=4~5)患者分别有7、22、13、20例,其完全缓解(CR)率分别为85.7%、59.1%、0、5.0%;中位总生存(OS)期分别为90.0、63.9、10.1和5.0个月,IPI为1~2分的患者中位OS期明显长于IPI为3~5分的患者(P<0.01),但IPI=1分和IPI=2分的患者比较,差异无统计学意义(P=0.3647).应用PIT评分系统,PIT为1分、2分、3~4分的患者分别有18、18、26例,其CR率分别为61.1%、44.4%、3.8%;中位OS期分别为90.0、46.9和5.0个月,三组患者生存期差异均具有统计学意义(P<0.01).单因素分析显示,B症状(P=0.025)、LDH水平升高(P=0.004)、骨髓浸润(P=0.023)和结外浸润(P=0.033)与患者OS期短显著相关.多因素分析显示,LDH水平升高(P=0.007)和骨髓浸润(P=0.016)是2个独立的预后指标,而且这两个因素正是PIT分层的重要指标.结论在老年T/NK细胞淋巴瘤患者中,PIT比IPI具有更好的预后指示作用.
목적 탐토노년T/NK세포림파류적예후상관인소.방법 수집상해교통대학의학원부속서금의원12년래수치적62례노년T/NK세포림파류환자적림상자료,안Ann Arbor분기、림상상태、결외루급、골수침윤상황、LDH수평등지표응용COX회귀모형진행예후상관인소적단인소화다인소통계분석.통과IPI혹PIT분층계통대T/NK세포림파류환자진행위험도분층,불동위험도조환자적총생존시간응용Log-rank검험진행조간비교.결과 근거IPI평분분조,저위조(IPI=1)、저중위조(IPI=2)、고중위조(IPI=3)、고위조(IPI=4~5)환자분별유7、22、13、20례,기완전완해(CR)솔분별위85.7%、59.1%、0、5.0%;중위총생존(OS)기분별위90.0、63.9、10.1화5.0개월,IPI위1~2분적환자중위OS기명현장우IPI위3~5분적환자(P<0.01),단IPI=1분화IPI=2분적환자비교,차이무통계학의의(P=0.3647).응용PIT평분계통,PIT위1분、2분、3~4분적환자분별유18、18、26례,기CR솔분별위61.1%、44.4%、3.8%;중위OS기분별위90.0、46.9화5.0개월,삼조환자생존기차이균구유통계학의의(P<0.01).단인소분석현시,B증상(P=0.025)、LDH수평승고(P=0.004)、골수침윤(P=0.023)화결외침윤(P=0.033)여환자OS기단현저상관.다인소분석현시,LDH수평승고(P=0.007)화골수침윤(P=0.016)시2개독립적예후지표,이차저량개인소정시PIT분층적중요지표.결론 재노년T/NK세포림파류환자중,PIT비IPI구유경호적예후지시작용.
Objective To analyze the prognostic related factors of elderly patients with T/NK cell lymphoma. Methods The clinical data of 62 T/NK cell lymphoma patients with age over 60 years and treated in Shanghai Jiaotong University Medical School affiliated Ruijin Hospital from 1999 to 2011 were collected and analyzed. Multivariate and univariate analysis of clinical data were performed using a COX regression model, including stage, performance status, extranodal infiltration, bone marrow involvement and LDH level. According to IPI or PIT systems, survival functions were estimated using the Kaplan-Meier method and compared by the log-rank test. Results Using the IPI system, the CR rate of the low risk (IPI=1, n=7), intermediate-low risk (IPI=2, n=22), intermediate-high risk (IPI=3, n=13) and high risk (IPI=4-5, n=20) groups were 85.7%, 59.1%, 0% and 5.0%, with the median overall survival (OS) of 90.0, 63.9, 10.1 and 5.0 months, respectively. The patients with IPI=1-2 had significant longer OS than those with IPI=3-5 (P<0.01), but no significant difference of OS was observed between IPI=1 and IPI=2 (P=0.3647). As for the PIT system, CR rate of patients with PIT=1 (n=18), PIT=2 (n=18) and PIT=3-4 (n=26) were 61.1%, 44.4% and 3.8%, with the median survival of 90.0, 46.9 and 5.0 months, respectively. Significant difference of OS was found among groups of PIT=1, PIT=2 and PIT=3-4 (P<0.01). Therefore, PIT index was more effective than IPI in predicting prognosis of elderly T/NK cell lymphoma patients. The significant parameters of the univariate analysis were B symptom (P=0.025), increased LDH level (P=0.004), bone marrow infiltration (P=0.023) and extranodal involvements (P=0.033). Multivariate analysis showed that only increased LDH level (P=0.007) and bone marrow involvement (P=0.016) were the two independent prognostic factors of survival. These two factors were included in PIT index. Conclusions PIT is more effective than IPI to predict outcomes of elderly T/NK lymphoma patients.