68例原发肠道弥漫大B细胞淋巴瘤患者的不同分期系统比较及预后分析

Comparison of Different Staging Systems and Prognostic Analysis in 68 Cases of Primary Intestinal Diffuse Large B Cell Lymphoma

目的:对比不同分期系统在原发肠道弥漫大B细胞淋巴瘤中的预后判断能力和分析其临床病理学特点、治疗与预后的相关性。方法:2009年1月至2017年7月原发肠道DLBCL患者共68例,所有患者均经过手术治疗。对患者分别使用Lugano分期、TNM分期、Blackledg分期及Musshoff分期系统进行分期;采用Kaplan-Meier法绘制生存曲线并行log-rank检验;应用受试者工作特征(ROC)曲线评价4个分期系统对生存率的预测价值;分析患者的临床特征、不同分期、治疗方案与生存预后的相关性。结果:患者的中位随访时间为52 (1-105)个月,中位PFS时间为41(1-86)个月,中位OS时间未能达到。常见发病部位为回盲部(30. 9%),其次为小肠(29. 4%)和结肠(29. 4%)、多部位受累(7. 4%)和直肠(2. 94%)。患者5年PFS率和OS率分别为44. 9%和51. 1%,KaplanMeier生存曲线及Log-rank检验结果显示,应用不同的分期系统描述PI-DLBCL患者PFS和OS的累积活存率时,4种分期系统均不能明显的区分开各期的生存曲线; ROC曲线结果显示,Lugano分期系统对PI-DLBCL患者1年PFS(AUC=0. 826; P=0. 015)和1年OS(AUC=0. 792; P=0. 001)预测能力较其他分期系统好。手术联合化疗(±放疗)组(62例)与单纯手术组(6例) 3年PFS率分别为53. 9%、16. 7%(P=0. 116),3年OS率分别为66. 7%、16. 7%(P=0. 015);联合利妥昔单克隆抗体化疗组(36例)较未联合化疗组(26例) 3年PFS率分别为66. 0%、44.0%(P=0. 139),3年OS分别为70. 2%和39. 2%(P=0. 148)。回盲部患者较其他部位发病患者有较高的PFS和OS(P均<0. 05)。多因素分析显示,仅骨髓侵犯是影响患者PFS的独立预后因素(P <0. 05)。结论:对于原发肠道DLBCL患者,骨髓侵犯是影响患者PFS的独立危险因素。从本组有限的数据初步得出,在4个分期系统中,Lugano分期对PI-DLBCL患者生存率的预测能力优于其它分期系统,可考虑将其作为PI-DLBCL生存率的预测指标。

Objective: To compare the prognostic value of different staging systems in primary intestinal diffuse large B cell lymphoma( PI-DLPCL),and their correlation with clinicopathological characteristics,treatment and prognosis of PI-DLBCL. Methods: A total of 68 patients w ith PI-DLBCL w ere recruited from January 2009 to July 2017. All the patients underw ent staging by using TNM,Lugano,Blackledge and M usshoff system,survival curves for the PI-DLBCL patients w ere plotted using the Kaplan-M eier method and w ere judged by the log-rank test. The accuracy of each staging system for predicting survival of PI-DLBCL patients w as evaluated by calculating the area under curve( AUC) of the receiver operating characteristic( ROC). The correlation of the 4 staging systems,clinical features patients and treatment regimes w ith PFS and OS w ere analysed. Results: The median follow-up time w as 52( 1-105) months,the median PFS time w as 41( 1-86) months,patients did not reached the median OS time. The most frequently involved site w as ileocecal( 30. 9%),follow ed by small intestine( 29. 4%) and colon( 29. 4%),multiple sites involvement( 7. 4%)and rectum( 2. 94%). The PFS and OS rates at 5-year w ere 44. 9% and 51. 1%,respectively. Kaplan-M eier survival curves and log-rank test results show ed that using different staging systems to describe the cumulative retention rates of PFS and OS in PI-DLBCL patients,none of the 4 staging systems can distinguish the survival curves of each stage significantly. The results of ROC curve show ed that the prediction ability of the Lugano staging system w as better than other staging system for 1 year PFS( AUC = 0. 826;P = 0. 015) and 1 year OS( AUC = 0. 792;P = 0. 001) in PI-DLBCL patients. The 3 year PFS rate in the operation + chemo or radio-therapy group( 62 cases) and the single operation group( 6 cases) were 53. 9% and 16. 7%,respectively( P = 0. 116),The 3 year OS rate were 66. 7% and 16. 7%( P = 0.015),respectively. Patients w ho received chemotherapy combined w ith rituximab had a higher 3-year PFS( 66. 0% vs44. 0%,P = 0. 139) and 3-year OS( 70. 2% vs 39. 2%,P = 0. 148). The patients w ith ileocecal lesion had higher PFS rate and OS rate than other sites( P < 0. 05). M ultivariate Cox regression analysis indicated that only bone marrow invasion w as an independent prognostic factor in patients w ith PFS. Conclusion: Bone marrow invasion is an independent risk factor for PFS in patients w ith PI-DLBCL,according to this limited preliminary data,Lugano staging system for stratifying and predicting the prognosis of PI-DLBCL patients is better than other staging system.