不同慢性淋巴细胞白血病分期体系对中国患者的适用性

 目的　探讨慢性淋巴细胞白血病（CLL）不同分期体系对中国患者的适用性。方法　回顾性分析2000年至2007年就诊于中国医学科学院血液病医院的218例CLL患者,根据不同的分期系统进行分期,并分析这些分期系统的预后价值。结果　Rai分期中0、Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者的5年总体生存（OS）率分别为（80.5±8.0）%、（79.7±6.7）%、（82.6±7.3）%、（46.1±19.7）%、（48.4±7.3）%;0期患者的OS优于Ⅲ、Ⅳ期患者（P均＜0.05）,Ⅰ期患者的OS优于Ⅳ期患者（P＜0.05）,其余各组间OS差异无统计学意义（P均＞0.05）。修改后的Rai分期中低、中、高危三组患者的5年OS率分别为（80.5±8.0）%、（80.9±5.0）%、（49.6±6.5）%;高危组患者的OS低于中、低危组患者（P均＜0.05）,而低、中危组间OS差异无统计学意义（P＞0.05）。Binet分期中A、B、C期患者的5年OS率分别为（79.9±5.3）%、（71.7±7.7）%、（51.6±6.8）%;A期患者的OS优于B、C期患者（P均＜0.05）,而B、C期间OS差异无统计学意义（P＞0.05）。GIMEMA分期中Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者的5年OS率分别为（85.1±4.5）%、（59.4±8.6）%、（64.3±9.5）%、（48.9±14.0）%;Ⅰ期患者的OS优于Ⅱ、Ⅲ、Ⅳ期患者（P均＜0.05）,其余各组间OS差异无统计学意义（P值均＞0.05）。按Montserrat等和法国协作组的定义可将Binet A期的患者分为"冒烟型"和"活动型"CLL,各种分组方法中的"冒烟型"和"活动型"之间在OS上差异均无统计学意义（P值均＞0.05）。结论　目前国外的CLL各种分期方式在中国患者的预后判断上均有不同程度的局限,需进一步探索纳入了新的预后因素的更适合中国患者的预后分期系统。

Applicability of different clinical staging systems in chronic lymphocytic leukemia for Chinese patients

Objective To explore the applicability of different clinical staging systems in chronic lymphocytic leukemia(CLL) for Chinese patients. Methods 218 cases of CLL patients from the Institute of Hematology and Blood Diseases Hospital during the year 2000 to 2007 were staged according to different clinical staging systems retrospectively,and the applicability of these systems was analysed. Results The 5-year overall survival(OS) rates of Rai 0, Ⅰ,Ⅱ, Ⅲ and Ⅳ group were (80.5±8.0) %, (79.7±6.7) %, (82.6±7.3) %, (46.1±19.7) % and (48.4±7.3) % respectively, being statistically different between stage 0 and Ⅲ/Ⅳ, Ⅰ and Ⅳ groups(P <0.05). For modified Rai staging system, the 5-year OS rates of low-, intermediate-and high-risk group were (80.5±8.0) %, (80.9±5.0) % and (49.6±6.5) % respectively, being statistically different between high-risk and intermediate/low-risk groups (P <0.05). The 5-year OS rates of Binet A, B and C group were (79.9±5.3) %, (71.7±7.7) % and (51.6±6.8) % respectively, being statistically different between A and B/C groups(P <0.05). The 5-year OS rates of GIMEMA Ⅰ , Ⅱ, Ⅲ and Ⅳ group were (85.1±4.5) %,(59.4±8.6) %, (64.3±9.5) % and (48.9±14.0) % respectively, being statistically different between Ⅰ and Ⅱ/Ⅲ /Ⅳ groups (P <0.05). By the definition of smouldering CLL according to Montserrat et al, or French Group criteria, the Binet A patients were divided into two groups:the smouldering group and the active group. No matter what criteria was used,there was no statistically difference in OS between the two groups (P >0.05). Conclusion There are limitations to some extent in the prognostic evaluation of available staging systems for Chinese CLL patients.A more suitable risk stratification system for Chinese CLL patients is required.