415例霍奇金淋巴瘤患者的疗效和预后因素分析

A analysis of the outcome and prognostic factors in 415 patients with Hodgkin lymphoma

目的：分析霍奇金淋巴瘤（ HL）患者的治疗情况和疗效，并探讨影响预后的因素。方法回顾性分析中国医学科学院肿瘤医院1999年2月至2011年2月间病理诊断明确、初治、资料齐全的415例HL患者的近期疗效、远期疗效和预后影响因素。结果全组治疗后完全缓解（ CR ）371例（89．4％），部分缓解33例（8．0％），疾病进展11例（2．7％）。Ⅰ、Ⅱ、Ⅲ和Ⅳ期患者的CR率分别为96．6％（56／58）、92．0％（219／238）、83．6％（51／61）和77．6％（45／58），差异有统计学意义（P＜0．001）。中位随访71个月，全组患者的5年无病生存率、5年无进展生存率和5年总生存率分别为90．6％、84．1％和92．5％。Ⅰ～Ⅱ期和Ⅲ～Ⅳ期HL患者的5年无病生存率分别为94．5％和79．2％，差异有统计学意义（P＜0．001）；5年无进展生存率分别为91．2％和66．4％，差异有统计学意义（P＜0．001）；5年总生存率分别为97．0％和81．5％，差异有统计学意义（ P＜0．001）。对于Ⅰ～Ⅱ期HL，综合治疗者的5年无病生存率（95．8％）明显优于单纯放疗者（78．6％， P＝0．004），但与单纯化疗者（91．3％）的差异无统计学意义（P＝0．269）；综合治疗者的5年无进展生存率（92．9％）明显优于单纯化疗者（82．1％， P＝0．026）和单纯放疗者（78．6％， P＝0．045）；综合治疗者的5年总生存率（97．6％）明显优于单纯放疗者（85．7％， P＝0．009），但与单纯化疗者（96．4％）的差异无统计学意义（P＝0．619）。对于Ⅲ～Ⅳ期HL，化疗缓解后放疗患者的远期生存有优于单纯化疗的趋势，尤其是化疗后部分缓解的患者，补充放疗明显提高了5年无进展生存率。多因素分析显示，分期和病理类型是影响HL患者5年无病生存率的独立因素（均P＜0．05）。分期、血清β2微球蛋白水平和化疗方案是影响HL患者5年无进展生存率的独立因素（均P＜0．05）。分期、血清β2微球蛋白水平和化疗方案是影响HL患者5年总生存率的独立因素（均P＜0．05）。结论 HL患者预后较好，Ⅰ～Ⅱ期患者首选化放疗联合的综合治疗；Ⅲ～Ⅳ期化疗后部分缓解者补充放疗可改善预后。分期、血清β2微球蛋白水平和一线化疗方案可能影响HL患者的预后。

Objective The aim of this study was to investigate the effectiveness of treatment, survival and prognostic factors in Chinese patients with Hodgkin lymphoma. Methods A total of previously untreated 415 patients with histologically confirmed Hodgkin lymphoma admitted in the Cancer Hospital, Chinese Academy of Medical Sciences from February 1999 to February 2011 were included in this study. Their short-term and long-term survivals, as well as prognostic factors were analyzed. Results For the whole group, 371 cases （89.4%） had complete remission （CR）, 33 cases （8.0%） had partial remission （PR） and 11 cases （2.7%） experienced disease progression. The CR rates for stage Ⅰ, Ⅱ, Ⅲ and Ⅳ patients were 96.6% （56/58）, 92.0% （219/238）, 83.6% （51/61） and 77.6% （45/58）, respectively （P〈0.001） . The 5-year disease-free survival（ DFS） , progression-free survival （ PFS） and overall survival （ OS） were 90.6%, 84.1% and 92.5%. The stageⅠ-Ⅱpatients were significantly better than stageⅢ-Ⅳpatientsin terms of 5-year DFS rate（94.5% vs. 79.2%, P〈0.001）, 5-year PFS rate （91.2% vs. 66.4%, P〈0.001） and 5-year OS rate （97.0% vs. 81.5%, P〈0.001）. For stage Ⅰ-Ⅱ patients, combined modality therapy was related to better DFS, PFS and OS as compared with radiotherapy alone, and was associated with a better PFS compared with chemotherapy alone. There was a trend that consolidative radiotherapy could improve the long-term survival for stage Ⅲ-Ⅳ patients who achieved disease remission after chemotherapy. What′s more, consolidative radiotherapy could significantly improve PFS for those stage Ⅲ-Ⅳ patients who achieved PR after chemotherapy. Multivariate analysis showed that clinical stage and pathological type were independent prognostic factors for the 5-year DFS rate （both P〈0.05）, and the stage, elevated serum β2-microglobulin and none-ABVD/BEACOP chemotherapy regimen were independent prognostic factors for 5-year PFS rate and 5-year overall survival rate （P〈0.05 for all）. Conclusions Patients with HL treated in China have a good prognosis. Combined modality therapy is the preferred treatment for stage Ⅰ-Ⅱ patients. Consolidative radiotherapy is recommended to those of stage Ⅲ-Ⅳ patients who experienced PR after chemotherapy. Stage, serum β2-microglobulin and first-line chemotherapy regimen significantly affect the prognosis for patients with Hodgkin lymphoma.