老年综合评估在老年弥漫大B细胞淋巴瘤治疗中的价值

目的　探讨老年综合评估（CGA）在老年弥漫大B细胞淋巴瘤（DLBCL）治疗中的应用价值。方法　本试验选取2015年１月至2017年12月在上海市松江区中心医院肿瘤血液科治疗的70例年龄≥65岁的DLBCL患者为研究对象，根据CGA标准将患者分为适合组、不适合组和脆弱组。分析3组患者临床资料与治疗疗效、预后和不良反应的相关性。采用卡方、Fisher精确概率法及秩和检验，生存分析采用Kaplan-Meier法，曲线间的比较采用log-rank检验。结果　70例患者，男39例、女31例，中位年龄69岁（65～89岁）。根据CAG分组标准，适合组35例（50.0%，35/70）、不适合组13例（18.6%，13/70）、脆弱组22例（31.4%，22/70）。与适合组、不适合组比较，脆弱组患者体力状况更差（ECOG评分）、淋巴瘤国际预后指数（IPI）评分高中危-高危组患者比例更高，差异有统计学意义（χ²=38.859、13.638，均P<0.01）。适合组、不适合组和脆弱组患者化疗有效率分别为100.0%（35/35）、100.0%（13/13）和36.4%（8/22），差异有统计学意义（χ²=38.182，P<0.01）。在3组患者中，≥3级血液学和非血液学不良反应差异均无统计学意义。随访2年，适合组、不适合组和脆弱组患者2年无进展生存（PFS）率分别为57.1%（20/35）、46.2%（6/13）、18.2%（4/22），差异有统计学意义（χ²=22.919，P<0.01）；在不适合组中，接受标准剂量化疗和低剂量化疗患者的化疗有效率和2年PFS比较，差异均无统计学意义。结论　CGA能更为全面地评估老年DLBCL患者身体状况，能有效预测治疗疗效、预后，对治疗决策有指导意义。

Value of comprehensive geriatric assessment in treatment for elderly patients with diffuse large B cell lymphoma

Objective　To explore the value ofcomprehensive geriatric assessment (CGA) in treatment for elderly patients withdiffuse large B cell lymphoma (DLBCL). Methods　Seventy ≥65years old patients with DLBCL treated at Department of Oncology and Hematology,Songjiang District Central Hospital from January 2015 to December 2017 wereenrolled in the study, and were divided into a fit group, an unfit group, and afrail group according to the CGA criteria. The correlations of the clinicalcharacteristics with the treatment efficacy, prognosis, and adverse reactionsin the three groups were analyzed. Chi-square test, Fisher's exact test, andrank sum test were applied. The Kaplan-Meier was used for survival analysis.The log-rank test was used for the comparison between curves. Results　Therewere 70 patients, including 39 males and 31 females, with a median age of 69(65-89). According to the CAG criteria, there were 35 (50.0%, 35/70) in the fitgroup, 13 (18.6%, 13/70) in the unfit group, and 22 (31.4%, 22/70) in the frailgroup. The patients had worse physical status (ECOG score) and more patientshad intermediate-high/high IPI risk class in the frail group than in the fitgroup and the unfit group, with statistical differences (χ²=38.859 and 13.638, both P<0.01). The overall response rate of chemotherapy was 100.0%(35/35) in the fit group, 100.0% (13/13) in the unfit group, and 36.4% (8/22)in the frail group, with a statistical difference (χ²=38.182,P<0.01).There were no statistical differences in the incidences of hematological andnon-hematologic adverse reactions of grade≥3between the 3 groups. The 2-year follow up showed that 2-year progression-freesurvival rates in the fit group, the unfit group, and the frail group were57.1% (20/35), 46.2% (6/13), and 18.2% (4/22), with a statistical difference (χ²=22.919, P<0.01). In the unfit group, therewere no statistical differences in the response rate of chemotherapy and 2-yearprogression-free survival rate between the patients treated by chemotherapy ofa standard dosage and the patients treated by chemotherapy of a low dosage. Conclusion　CGA may be more comprehensive in assessing the physical conditionsof elderly patients with DLBCL, can effectively predict the therapeutic effectand prognosis, and provide assistance for guiding therapeutic strategies.