203例慢性淋巴细胞白血病患者预后相关因素分析

Prognostic factor analysis in 203 patients with chronic lymphocytic leukaemia

目的探讨慢性淋巴细胞白血病（CLL）患者预后的主要影响因素。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并获得有效随访的203例CLL患者临床资料，收集可能影响预后的因素，以Kaplan—Meier法绘制生存曲线，用Log—rank检验进行单因素分析，运用COX回归模型评估独立预后因素。结果全组CLL患者中位随访时间为48．0（3．0～156．0）个月，5年总体生存（OS）率为（87．3±2．4）％，10年OS率为（77．4±3．3）％，死亡48例（23．6％）。单因素分析显示临床分期为晚期、有B症状、结外器官受累、受累淋巴区≥3个、肝脏肿大、Hb〈100g／L、BPC〈100×10^9／L、外周血淋巴细胞计数（ALC）〉50×10^9／L、形态学表现为混合细胞型、病程中出现分期进展、对治疗无反应、并发感染、并发第二肿瘤或类型转化为不良预后因素。多因素分析显示受累淋巴区≥3个和形态学表现为混合细胞型为独立的不良预后因素，根据这两项结果重新分组，低危、中危、高危组患者5年OS率分别为（89．8±3．5）％、（66．4±7．2）％、（15．0±13．8）％，各组间差异均具有统计学意义（P值均〈0．05）。结论初诊时受累淋巴区数和CLL细胞形态学特征有助于评估CLL患者的预后。

Objective To explore prognostic factors in patients with chronic lymphocytic leukemia （CLL）. Methods Two hundred and three CLL patients in our hospital between 2000 to 2007 were retro-spectively reviewed for prognostic factor analysis. Survival was analysed by Kaplan-Meier analysis, univariate analysis by Log-rank test and multivariate analysis by COX regression model. Results With a median follow- up time of 48.0 （3.0 - 156. 0） months, the 5-year overall survival （OS） rate was （ 87.3 ± 2.4 ） % and 10- year OS rate was （77.4±3.3 ） %. Forty-eight （23.6%） patients died. Univariate analysis indicated that advanced clinical stage, B symptoms, extranodal involvement, number of lymph node regions involved≥3, enlarged liver, Hb 〈 100 g/L, BPC 〈 100 ×10^9/L, absolute lymphocyte count （ALC） 〉50 × 10^9/L, atypical cell morphology, progression to stage, non-respons to treatment, complicating infections and secondary cancer or disease transformation were associated with poor prognosis. And on multivariate analysis, lymph node region involved ≥ 3 and atypical cell morphology were independent poor prognostic factors. Based on the two independent poor prognostic factors, three risk groups were defined： low- （0 factor）, intermediate-（ one factor） and high-（ two factors） groups. The 5 year OS rates were （ 89.8 ± 3.5 ） %, （ 66.4 ± 7.2） % and （ 15.0 ± 13.8 ） % , respectively, and the difference between them was statistically. Conclusion The number of lymph node region involved and cell morphology are useful for assessing CLL patients prognosis.