CAJ | 학술논문

目的：评价应用CHOPE与CHOPE-L方案治疗外周T细胞淋巴瘤非特异型(PTCL-U)的效果及其预后影响因素。方法对2005年1月~2012年1月经中国医科大学附属盛京医院病理及免疫组化确诊的65例PTCL-U患者的资料进行回顾性分析，评价CHOPE与CHOPE-L方案的治疗效果及其预后影响因素。结果20例应用CHOPE方案治疗，完全缓解(CR)4例(20.0%)，部分缓解(PR)5例(25.0%)，总有效率(OR)为45.0%；1、2、3年的总生存率分别为75.0%、40.0%及15.0%。45例应用CHOPE-L方案治疗，CR 12例(26.7%)，PR 19例(42.2%)，OR为68.9%；1、2、3年的总生存率分别为82.2%、62.2%及40.0%。 Ann Arbor分期Ⅰ~Ⅱ期、结外侵犯0~1个、无骨髓侵犯、Ki-67≤50%及应用CHOPE-L方案的患者较Ann Arbor分期Ⅲ~Ⅳ期、结外侵犯≥2个、有骨髓侵犯、Ki-67>50%及应用CHOPE方案的患者化疗有效率高，差异有统计学意义(P<0.05)。一般状况评分(ECOG评分)0~1分、国际预后指数(IPI)评分≤2分、Ki-67≤50%及应用CHOPE-L方案化疗的患者较ECOG评分2~4分、IPI评分>2分、Ki-67>50%及应用CHOPE方案化疗的患者3年生存率高，差异有统计学意义(P<0.05)。多因素分析显示，IPI评分是本组病例的独立预后因素(P<0.05)。结论 PTCL-U是一类预后不良的疾病，左旋门冬酰胺酶(L-ASP)的应用提高了化疗有效率及3年生存率，且安全性好，不良反应可耐受。 Ann Arbor分期、结外侵犯、骨髓侵犯、Ki-67及化疗方案是影响近期疗效的重要因素。患者的ECOG评分、IPI评分、Ki-67及化疗方案是影响患者预后的重要因素。
목적：평개응용CHOPE여CHOPE-L방안치료외주T세포림파류비특이형(PTCL-U)적효과급기예후영향인소。방법대2005년1월~2012년1월경중국의과대학부속성경의원병리급면역조화학진적65례PTCL-U환자적자료진행회고성분석，평개CHOPE여CHOPE-L방안적치료효과급기예후영향인소。결과20례응용CHOPE방안치료，완전완해(CR)4례(20.0%)，부분완해(PR)5례(25.0%)，총유효솔(OR)위45.0%；1、2、3년적총생존솔분별위75.0%、40.0%급15.0%。45례응용CHOPE-L방안치료，CR 12례(26.7%)，PR 19례(42.2%)，OR위68.9%；1、2、3년적총생존솔분별위82.2%、62.2%급40.0%。 Ann Arbor분기Ⅰ~Ⅱ기、결외침범0~1개、무골수침범、Ki-67≤50%급응용CHOPE-L방안적환자교Ann Arbor분기Ⅲ~Ⅳ기、결외침범≥2개、유골수침범、Ki-67>50%급응용CHOPE방안적환자화료유효솔고，차이유통계학의의(P<0.05)。일반상황평분(ECOG평분)0~1분、국제예후지수(IPI)평분≤2분、Ki-67≤50%급응용CHOPE-L방안화료적환자교ECOG평분2~4분、IPI평분>2분、Ki-67>50%급응용CHOPE방안화료적환자3년생존솔고，차이유통계학의의(P<0.05)。다인소분석현시，IPI평분시본조병례적독립예후인소(P<0.05)。결론 PTCL-U시일류예후불량적질병，좌선문동선알매(L-ASP)적응용제고료화료유효솔급3년생존솔，차안전성호，불량반응가내수。 Ann Arbor분기、결외침범、골수침범、Ki-67급화료방안시영향근기료효적중요인소。환자적ECOG평분、IPI평분、Ki-67급화료방안시영향환자예후적중요인소。
Objective To investigate the treatment response and prognostic factors in patients with peripheral T cell lymphomas-unspecified (PTCL-U) treated by CHOPE and CHOPE-L chemotherapy. Methods The clinical data of 65 pathology and immunohistochemistry confirmed patients with PTCL-U in Shengjing Hospital Affiliated to China Medi-cal University from January 2005 to January 2012 were retrospectively analyzed, in order to evaluate the treatment re-sponse and prognosic factors of CHOPE and CHOPE-L chemotherapy. Results Of 20 cases treated by CHOPE, com-plete remission (CR) rate was 20.0% (4/20), partial remission (PR) rate was 25.0% (5/20) and overall response (OR) rate was 45.0%.The overall survival rates of 1, 2 and 3 years was 75.0%, 40.0% and 15.0% respectively. Of 45 cases treated by CHOPE-L, CR rate was 26.7% (12/45), PR rate was 42.2% (19/45) and OR rate was 68.9%. The overall survival rates of 1, 2 and 3 years was 82.2%, 62.2% and 40.0% respectively. Ann Arbor stage Ⅰ-II, extranodal in-volvement of 0-1, the patients without bone marrow involvement, Ki-67≤50% and the application of CHOPE-L chemotherapy had a better recent curative effect compared with Ann Arbor stage Ⅲ-Ⅳ, extranodal involvement of more than two, the patients with bone marrow involvement, Ki-67 > 50% and the application of CHOPE chemotherapy (P < 0.05). ECOG scoring 0-1, International prognostic index (IPI) ≤2, Ki-67≤50% and the application of CHOPE-L chemotherapy had a higher 3-year overall survival rate compared with ECOG scoring 2-4, IPI scoring>2, Ki-67>50%and the application of CHOPE chemotherapy (P<0.05). Multi-factors analysis of IPI scoring was independent prognostic factors in this group of patients (P<0.05). Conclusion PTCL-U is a kind of disease with poor prognosis. The use of L-asparaginase (L-ASP) improves the rate of response to chemotherapy and survival rate in 3 years. The security is good and the side effects can be tolerated. Ann Arbor stage, extranodal involvement, bone mar-row involvement, Ki-67 and CHOPE-L chemotherapy are important factors affecting the recent curative effect. ECOG score, IPI score, Ki-67 and CHOPE-L chemotherapy are important prognostic factors.