改良国际预后指数(NCCN-IPI)对R-CHOP方案治疗弥漫大B细胞淋巴瘤的预后评估(附168例临床分析)

Prognostic significance of an enhanced International Prognostic Index(NCCN-IPI)for patients with diffuse large B-cell lymphoma treated with R-CHOP:a case report of 168 patients

目的：验证改良国际预后指数（NCCN—IPI）对弥漫大B细胞淋巴瘤（DLBCL）患者免疫化疗后的预后评估价值。方法：回顾性分析天津医科大学肿瘤医院2008年1月至2013年1月收治的168例初治DLBCL患者的临床特征及预后，采用NCCN—IPI和国际预后指数（IPI）进行危险度分层和预后评估。结果：全组患者中住年龄58（24—80）岁，男性92例（54．8％），AnnArbor分期Ⅲ-Ⅳ期94例（56．0％），ECOGPSi2分19例（11.3％）；发病时LDH水平升高（〉245U／L）占71．4％。中位随访42（15～88）个月，3年和5年生存率（OS）分别为（75．9±3.4）％、（65．1±5．2）％。全组患者根据IPI评分系统，低危组占30．4％，中低危27．4％，中高危25．0％，高危17．3％；3年OS分别为91．8％、76．7％、67．9％和47．1％。根据NCCN—IPI评分，低危组19．0％，中低危38．1％，中高危31．5％，高危11．3％。3年OS分别为94．5％、85．4％、61．2％和38．1％。与IH评分相比，NCCN—IPI评分区分高危和低危患者的能力更强（NCCN—IPI：3年OS：94．5％眠38．1％；IPI：91．8％vs．47．1％）。结论：在利妥昔单抗一线治疗中，与IPI指数相比，NCCN—IPI更好地整合了年龄和LDH水平两个变量的预后作用，可作为DLBCL患者强有力的预后分层工具。

Objective： To validate the prognostic value of an enhanced International Prognostic Index （NCCN-IPI） for diffuse large B-cell lymphoma （DLBCL） patients treated with R-CHOP. Methods： A total of 168 DLBCL patients who were initially diagnosed and treated in Tianjin Medical University Cancer Institute and Hospital from January 2008 to January 2013 were included in the study. Baseline characteristics were collected, and survival analysis was performed using the standard IPI and the new NCCN-IPI model. Re- suits： The main clinical features were as follows： mean age was 58 （range： 24-80） years old, 54.8% of them were male, 56% were stage Ⅲ/Ⅳ disease, 11.3% were Eastern Cooperative Oncology Group Performance Status （ECOG PS）≥2, and 71.4% had elevated lactate de- hydrogenase level （〉245 U/L）. After a median follow-up of 42 （range： 15-88） months, the 3- and 5-year overall survival （OS） rates were 75.9%± 3.4% and 65.1% ±5.2%, respectively. According to the old IPI risk categorization, 30.4%, 27.4%, 25.0%, and 17.3% pa- tients belonged to the four risk subgroups （low, low-intermediate, high-intermediate, and high）. The corresponding percentages were 19.0%, 38.1%, 31.5%, and 11.3% in the NCCN-IPI model. The 3-year OS for the four NCCN-IPI risk groups were 94.5%, 85.4%, 61.2%, and 38.1%, respectively, whereas the rates were 91.8%, 76.7%, 67.9%, and 47.1% for the IPI risk groups. Compared with the IPI, the NCCN-IPI better discriminated low- and high-risk subgroups （3-year OS： 94.5% vs. 38.1%） than the IPI （3-year OS：91.8% vs. 47.1%）, respectively. Conclusion： Compared with IPI, NCCN-IPI better incorporated two known prognostic variables, i.e., age and LDH, and was thus a more powerful prognosticator for DLBCL patients in the rituximab-based era.