| 首次复发?难治原发性中枢神经系统淋巴瘤预后影响因素分析 |
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| 引用本文： | 黄燕,陈波斌,李佩,袁燕,马燕,丁天凌,王义霞,许小平. 首次复发?难治原发性中枢神经系统淋巴瘤预后影响因素分析[J]. 中国肿瘤临床, 2018, 45(19): 985-993. DOI: 10.3969/j.issn.1000-8179.2018.19.751 |
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| 作者姓名： | 黄燕 陈波斌 李佩 袁燕 马燕 丁天凌 王义霞 许小平 |
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| 作者单位： | ①.复旦大学附属华山医院血液科（上海市200040） |
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| 摘 要： | 目的 分析复发/难治原发性中枢神经系统淋巴瘤（primary central nervous system lymphoma，PCNSL）患者临床特点并探讨其影响预后的因素，为临床诊疗提供依据。 方法 选取复旦大学附属华山医院2006年10月至2015年8月确诊的64例复发/难治PCNSL患者的病例资料、治疗方案、实验室辅助检查指标进行回顾性分析。采用Cox回归多因素分析。 结果 单因素和多因素分析结果显示，首次无疾病进展生存期（progression-free survival of first time，PFS1）≤1年、Karnofsky评分（Karnofsky performance score，KPS） < 70分为影响复发/难治PCNSL预后的独立危险因素。PFS1≥1年患者中位第二次无疾病进展生存期（median progression-free survival of second time，mPFS2）和中位第二次总生存时间（median overall survival of second time，mOS2）分别为19个月和21个月，而PFS1 < 1年患者mPFS2和mOS2分别为10个月和14个月。复发/难治时KPS评分≥70分患者与KPS评分 < 70分患者mPFS2分别为40个月和10个月，mOS2分别为43个月和12个月。另外，单因素分析首次复发/难治PCNSL患者选用含有大剂量甲氨蝶呤（high-dose methotrexate，HD-MTX）化疗方案的mPFS2为18个月，而选用不含HD-MTX化疗方案的mPFS2为10个月，差异具有统计学意义。多因素分析结果显示，挽救方案为影响患者PFS的相关因素；单因素分析结果显示，挽救方案含有HD-MTX与不含有HD-MTX组的mOS2分别为23个月和12个月，差异无统计学意义，考虑与样本量较小有关。 结论 PFS1≤1年、KPS评分 < 70分是影响复发/难治PCNSL预后的独立危险因素。首次复发/难治PCNSL患者挽救治疗继续给予HD-MTX为基础的化疗方案可能会提高患者的远期疗效。
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| 关 键 词： | 复发 难治 原发性中枢神经系统淋巴瘤 预后 |
| 收稿时间： | 2018-07-18 |
Analysis of prognostic factors of the first relapsed/refractory primary central nervous system lymphoma |
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| Affiliation: | ①.Department of Hematology, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China②.Department of Hematology, the Second People's Hospital of Kashi, Kashi 844000, China |
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| Abstract: | Objective To analyze the clinical characteristics of patients with relapsed/refractory primary central nervous system lymphoma (PCNSL) and to explore the factors that influence the prognosis, in order to provide evidence for the clinical diagnosis and treatment. Methods Sixty-four patients with relapsed/refractory PCNSL diagnosed from October 2006 to August 2015 were selected. The clinical features, treatment plans, and laboratory examination data were retrospectively analyzed. Cox regression was used for multivariate analysis. Results Univariate and multivariate analyses showed that progression-free survival of first time (PFS1)≤1 year and Karnofsky performance status (KPS) score < 70 points were independent prognostic factors in patients with first relapsed/refractory PCNSL. The median PFS2 and overall survival of second time (OS2) were 19 and 21 months, respectively, in patients with PFS1≥1 year, whereas the median progression free survival of second time (mPFS2) and OS2 were 10 and 14 months, respectively, in patients with PFS1 < 1 year. The median PFS2 (mPFS2) in patients with first relapse/refractory KPS score ≥70 points and those with KPS score < 70 points were 40 and 10 months, respectively, and the median OS2 were 43 and 12 months, respectively. The median PFS for the methotrexate (MTX) and non-MTX groups was 18 and 10 months, respectively. Multivariate analysis showed that the salvage therapy was a relevant factor influencing the patient's PFS. However, univariate analysis showed that the median OS2 in the MTX and non-MTX groups was 23 and 12 months, respectively, with significant difference but without any correlation with prognosis. Conclusions progression-free survival (PFS)≤1 year and KPS score < 70 were independent prognostic factors in patients with first relapsed/refractory PCNSL. Patients with relapsed/refractory PCNSL who continuously received high-dose MTX-based treatment may have improved long-term treatment outcomes. |
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