早期霍奇金淋巴瘤的预后多因素分析

Multi-variate analysis of the prognostic factors for early stage Hodgkin's lymphoma

目的:目前对于早期霍奇金淋巴瘤(Hodgkin’s lymphoma,HL)的预后因素仍存有争议,本研究旨在探讨早期HL的预后因素。方法:回顾性分析188例早期HL患者,其中100例(53.2%)接受单纯放疗,88例(46.8%)接受联合放化疗。采用Kaplan-Meier生存分析并log-rank检验,估计5年、10年总生存(overall survival,OS)率和无病生存(disease-free survival,DFS)率,用COX比例风险模型确定早期HL的预后因素。结果:单纯放疗和联合放化疗的5年、10年OS率分别为84.5%、76.3%和96.2%、96.2%(P=0.340),5年、10年DFS率分别为84.7%、76.9%和93.4%、71.8%(P=0.015)。单因素分析表明肿瘤大小、年龄(以40岁为分界点)预测OS和DFS差异有统计学意义,其P值分别为0.002和0.001、0.033和0.019;病理类型预测OS接近有统计学意义(P=0.072);有无B症状预测DFS接近有统计学意义(P=0.072)。多因素分析表明年龄(P=0.022)、性别(P=0.036)、肿瘤大小(P=0.024)、淋巴结受侵区域数目(受侵数目≥3个)(P=0.060)和临床分期(P=0.028)共5个因素有统计学意义或接近有统计学意义。结论:年龄≥40岁、男性、临床Ⅱ期、肿瘤体积较大或大纵隔、淋巴结区域受侵数目≥3个为早期HL独立的不良预后因素。

Objective：There is controversy about the prognostic factors for early stage Hodgkin＇s lymphoma （HL）. The aim of this study is to investigate the prognostic factors for HL at early stage. Methods： The clinical data from 188 patients were analyzed retrospectively. One hundred patients （ 53.2% ） received radiotherapy （RT） alone and 88 cases （46.8%） received combined chemotherapy and radiotherapy. The 5-year and 10-year overall survival （OS） and disease-free survival （DFS） rates were estimated by Kaplan-Meier survival analysis with log-rank test. The prognostic factors were determined by COX proportional hazards model. Results： The 5-year and 10-year OS rates were 84.5% and 76.3% for patients who received radiotherapy alone, respectively; they were 96.2% and 96.2% for those patients who received combined chemotherapy and radiotherapy, respectively （P = 0. 340）. The 5-year and 10-year DFS rates were 84.7% and 76.9% for patients who received radiotherapy alone, respectively; they were 93.4% and 71.8% for patients who received combined therapy, respectively （P =0. 015 ）. Univariate analysis indicated that tumor size and patients＇ age （with the cut-off of 40 years old） were the prognostic factors for predicting OS （P =0.002 and 0.001 ） and DFS rate （P =0.033 and 0.019 ）. The pathological type had marginal significance in predicting OS rate （P = 0.072 ） and B symptoms had marginal significance in predicting DFS rate （P = 0. 072 ）. Multivariate analysis indicated that five factors including age （P = 0.022 ）, gender （P = 0.036 ）, tumor size （ P = 0. 024 ）, the drainage areas of involved lymph nodes （ with the cut-off of 3 areas） （ P = 0. 060 ）, and clinical stage （P = 0.028 ） had significance or marginal significance for predicting HL. Conclusion： Being more than 40 years old, male, clinical stage Ⅱ , bulky disease, and the number of involved mediastinum and lymph node regions ≥3 are the independent prognostic factors for patients with early HL.