56例老年弥漫大B淋巴瘤预后相关因素的研究

目的：探讨老年弥漫大B细胞淋巴瘤（DLBCL）的预后相关因素。方法回顾性分析2007年8月-2012年7月沈阳市第四人民医院收治的56例老年DLBCL患者的年龄、Ann-Arbor分期、B症状、体能状态ECOG评分、骨髓浸润、最大肿块直径、乳酸脱氢酶（LDH）、β2-微球蛋白（β2-MG）、国际预后评分指数（IPI）、细胞来源、Ki-67指数、治疗方案等临床资料，研究上述指标与预后的相关性。结果56例患者中位生存时间为25.2个月，2年总生存（OS）率为49.7%，总完全缓解（CR）率为50.0%；CHOP方案组CR 13例（40.6%），利妥昔单抗（Rituximab）联合CHOP（R-CHOP）方案组CR 15例（62.5%），R-CHOP组的总有效率及CR率均优于CHOP组（均P〈0.05）。单因素分析显示：年龄≥80岁、Ann Arbor分期、骨髓受累、ECOG评分、最大肿块直径≥10cm、IPI、治疗前LDH值、免疫分型、治疗方案均与预后有关（P〈0.05或P〈0.01）；COX回归多因素分析表明，IPI、骨髓浸润、免疫分型、化疗方案是影响老年DLBCL患者预后的独立危险因素（P〈0.05或P〈0.01）。结论老年DLBCL具有肿瘤分期晚、合并疾病多、疗效差、生存期短等特点；IPI、骨髓浸润、免疫分型、化疗方案是老年DLBCL预后的独立危险因素；R-CHOP方案能提高疗效及改善预后。

Research on relevant factors of prognosis of 56 elderly patients with DL-BCL

Objective To study the prognostic factors of elderly patients with diffuse large B-cell lymphoma （DLBCL）. Methods Clinical data of 56 cases of DLBCL patients admitted by the Fourth People＆#39;s Hospital of Shenyang City from August 2007 to July 2012 were retrospectively analyzed, including the age, Ann-Arbor staging, B symptoms, ECOG score of performance status, bone marrow invasion, the maximum diameter of tumor, LDH,β2-MG, IPI, cell source, Ki-67 index, therapeutic regimen. The correlation between these indexes and prognosis was analyzed. Results For the 56 patients, the median survival time was 25.2 months, and the overall survival （OS） rate was 49.7% in the two years, total complete remission （CR） rate was 50.0%. 13 cases （40.6%） with CR were in CHOP scheme group, 15 cases （62.5%） with CR were in R-CHOP scheme group. The general rate of effectiveness and CR of R-CHOP were higher than that of CHOP group （all P〈0.05）. Single factor analysis showed that age≥80, Ann Arbor staging, bone marrow involvement, ECOG score, the maximum diameter of tumor ≥10 cm, IPI score, value of LDH before treatment, immunophenotyping, therapeutic regimen were all related with prognosis （P〈 0.05 or P〈0.01）. COX regression multiple-factor analysis in-dicated that IPI, bone marrow invasion, immunophenotyping and chemotherapy were separate hazardous factors which affected the prognosis of the old patients with DLBCL （P〈0.05 or P〈0.01）. Conclusion The DLBCL for the old is char-acterized in late tumor staging, various combined diseases, poor curative effect, short survival time, etc. IPI, bone mar-row invasion, immunophenotyping and chemotherapy are separate hazardous factors which affect the prognosis of the old patients with DLBCL. The R-CHOP scheme will enhance curative effect and improve prognosis.