摘要
目的分析初治原发结外弥漫大B细胞淋巴瘤(PE-DLBCL)预后的影响因素。方法选择初次接受系统治疗的原发PE-DLBCL患者151例,收集患者的临床资料,包括年龄、性别、临床分期、伴发全身性B症状、美国东部肿瘤协作组(ECOG)评分、结外累及数目、原发部位、国际预后指数(IPI)评分、血红蛋白浓度(HGB)、血清白蛋白(ALB)、乳酸脱氢酶(LDH)水平、β_(2)微球蛋白(β_(2)-MG)、Ki-67、细胞来源、双表达淋巴瘤(DEL)表型、治疗方案和临床疗效等。对患者进行随访,根据患者生存情况,采用Kaplan-Meier法绘制生存曲线并计算3年总生存期(OS)率和无进展生存期(PFS)率,使用Log-Rank检验法进行单因素分析,应用Cox比例风险模型进行多因素分析。结果151例患者中,97例生存、39例死亡、15例因未行系统检查无法评估疾病状态,3年PFS率为(66.9±4.6)%,3年OS率为(74.2±4.5)%。单因素分析结果显示,影响PE-DLBCL患者3年PFS率的相关因素为年龄>60岁、骨髓来源、原发于胃肠道、原发中枢神经系统(CNS)、IPI>2分、HGB<110 g/L、LDH升高、非生发中心B细胞样(non-GCB)来源、DEL表型、4个疗程未达CR(P均<0.05),影响PE-DLBCL患者3年OS率的相关因素为年龄>60岁、结外累及数目≥2个、骨髓来源、原发于胃肠道、原发CNS、IPI>2分、HGB<110 g/L、non-GCB来源、DEL表型、4个疗程未达CR(P均<0.05)。多因素分析结果显示,骨髓来源、原发CNS是PE-DLBCL患者3年PFS率的独立影响因素(P均<0.05),原发CNS、HGB<110 g/L、non-GCB来源、DEL表型是PE-DLBCL患者3年OS率的独立影响因素(P均<0.05)。结论骨髓来源、原发CNS、HGB<110 g/L、non-GCB来源、DEL表型等是初治原发PE-DLBCL预后的影响因素,可作为预后评价的参考指标。
Objective To analyze the prognostic factors of primary extranodal diffuse large B-cell lymphoma(PEDLBCL).Methods Totally 151 patients with PE-DLBCL who received first-line systemic treatment were retrospectively selected.The clinical data,including age,gender,clinical stage,presence of systemic B symptoms,Eastern Cooperative Oncology Group(ECOG)performance status,the number of extranodal sites involved,primary site,International Prognos⁃tic Index(IPI)score,hemoglobin(HGB)level,serum albumin(ALB)level,lactate dehydrogenase(LDH)level,β_(2)-mi⁃croglobulin(β_(2)-MG)level,Ki-67 index,cell-of-origin subtype,double-expressor lymphoma(DEL)phenotype,treatment regimens,and clinical outcomes were collected.Patients were followed up.Based on survival status,the Kaplan-Meier method was used to plot survival curves and we calculated the 3-year overall survival(OS)rate and progression-free surviv⁃al(PFS)rate.Univariate analysis was performed using the Log-Rank test,and multivariate analysis was conducted using the Cox proportional hazards model.Results Among the 151 patients,97 survived,39 died,and 15 were not evaluable for disease status due to lack of systematic examination.The 3-year PFS rate was(66.9±4.6)%,and the 3-year OS rate was(74.2±4.5)%.Univariate analysis showed that factors significantly associated with the 3-year PFS rate included age>60 years,bone marrow involvement,primary site in the gastrointestinal tract,primary central nervous system(CNS)lymphoma,IPI score>2,HGB<110 g/L,elevated LDH,non-germinal center B-cell-like(non-GCB)subtype,DEL phenotype,and failure to achieve complete remission(CR)after 4 treatment cycles(all P<0.05).Factors significantly as⁃sociated with the 3-year OS rate included age>60 years,involvement of≥2 extranodal sites,bone marrow involvement,primary site in the gastrointestinal tract,primary CNS lymphoma,IPI score>2,HGB<110 g/L,non-GCB subtype,DEL phenotype,and failure to achieve CR after 4 treatment cycles(all P<0.05).Multivariate analysis indicated that bone mar⁃row involvement and primary CNS lymphoma were independent risk factors for the 3-year PFS rate(both P<0.05).Mean⁃while,primary CNS lymphoma,HGB<110 g/L,non-GCB subtype,and DEL phenotype were independent risk factors for the 3-year OS rate(all P<0.05).Conclusions Bone marrow involvement,primary CNS lymphoma,HGB<110 g/L,non-GCB subtype,and DEL phenotype,etc.are significant prognostic factors in patients with PE-DLBCL,and they can serve as reference indicators for prognostic evaluation.
作者
徐成波
黄彩玲
洪士森
李灿灿
郑瑞玑
XU Chengbo;HUANG Cailing;HONG Shisen;LI Cancan;ZHENG Ruiji(Department of Hematology,Fujian Provincial People’s Hospital,Fuzhou 350004,China;不详)
出处
《山东医药》
2026年第1期109-113,共5页
Shandong Medical Journal
基金
福建省自然科学基金项目(2025J01899)
福建省科技创新联合资金项目(2024Y9594)。
