200例非霍奇金淋巴瘤预后分析

目的探讨中高度非霍奇金淋巴瘤预后改善。方法对２００例经化学治疗的患者进行预后因素分析。应用多因素Ｃｏｘ模型分析年龄、性别、临床分期、Ｂ症状、淋巴结外病灶、骨髓侵犯、巨大肿块、体力状况和病理恶性度等因素。结果体力状况、结外病灶、病理恶性度和巨大肿块对预后具有显著意义。按预后指数（ＰＩ）将患者分为低危组（ＰＩ为－２．４３～－１．３０）、中危组（ＰＩ为－１．２９～１．０）和高危组（ＰＩ＞１．０）,其５年生存率分别为７６．０％、２１．６％及７．４％。结论预后分组可用于指导治疗,据此,高危组可考虑采用更强烈化疗及自体造血干细胞移植,中危组及低危组可采用标准化疗方案。这将有助于改善患者的预后。

Multivariate analysis on prognostic factors of non-Hodgkin's lymphoma

OBJECTIVE: To predict the prognostic factors and to improve the response and survival in intermediate-grade and high-grade non-Hodgkin lymphoma (NHL). METHODS: 200 patients with intermediate-grade and high-grade NHL were treated with chemotherapy. A multivariate Cox model was used to analyse the prognostic factors that significantly affect the treatment outcome. The variables examined included: sex, age, clinic stage of disease, B symptoms, extranodal sites, bone marrow involvement, tumor bulk, performance status (ECOG) and malignancy grades. RESULTS: Multivariate analysis showed that performance status, the number of extranodal sites, pathologic malignancy grade and tumor bulk were significantly independent prognostic factors. These factors were put together to construct a prognostic index formula. The index partitioned the patients into low risk group (PI -2.43(-)-1.30), intermediate risk group (PI -1.29-1.0) and high risk group (PI > 1.0) giving 5-year survival rates of 76.0%, 21.6% and 7.4%, respectively. CONCLUSION: The prognostic index formula and subgroups could serve as a reference to distinguish patients requiring more intensive chemotherapy and autologous stem cell transplantation from those who should be treated with standard regimens in order to improve the prognosis.