123例原发韦氏环弥漫大B细胞淋巴瘤临床特征与预后分析

Clinical Characteristics and Prognosis of 123 Patients with Diffuse Large B-cell Lymphoma of Waldeyer's Ring

目的探讨原发韦氏环弥漫大B细胞淋巴瘤（Waldeyer’s ring diffuse large B-cell lymphoma,WR-DLBCL）的临床特征、预后因素及治疗策略。方法回顾性分析天津医科大学肿瘤医院2006年1月至2014年6月收治的123例初治原发韦氏环DLBCL患者,对其临床特征、治疗方式及生存情况比较分析,Kaplan-Meier法计算3、5年生存率,Log rank检验单因素分析,Cox比例风险模型多因素分析。结果 123例患者中位年龄为56岁（16~80岁）,男72例。Ann Arbor分期：Ⅰ期20例,Ⅱ期63例,Ⅲ期23例,Ⅳ期17例。中位随访54月,3年和5年生存率分别为74.7%和56.3%,早期（Ⅰ/Ⅱ期）患者3年和5年生存率分别为84.2%和69.4%。单因素分析显示：年龄、体质状况、B症状、临床分期、国际预后指数（IPI）、乳酸脱氢酶（LDH）水平、近期疗效是影响预后的主要因素;多因素分析显示：IPI评分和近期疗效为独立预后因素。结论原发韦氏环DLBCL多为早期,肿瘤负荷较轻,生存率较高,多数可长期生存。IPI评分和近期疗效是独立预后因素。

Objective To investigate the clinical characteristics, prognostic factor and treatment strategy of primary Waldeyer＇s ring diffuse large B-cell lymphoma（WR-DLBCL） patients. Methods A total of 123 WR-DLBCL patients who were initially diagnosed and treated in Tianjin Medical University Cancer Institute and Hospital from January 2006 to June 2014 were retrospectively analysed, including clinical characteristics, treatment and survival. Kaplan-Meier method was used for evaluating the 3- and 5-year overall survival（OS） rates. Log-rank method was used to evaluate the significance tests. Multivariate analysis was carried out with the Cox proportional hazard model. Results Among 123 patients, the median age was 56（16-80） years old, including 72 males. Twenty patients were Ann Arbor stageⅠ, 63 patients were stageⅡ, 23 patients were stage Ⅲ, and 17 patients were stage Ⅳ. After a median follow-up of 54 months, the 3- and 5-year OS were 74.7% and 56.3%, and those of stageⅠ-Ⅱwere 84.2% and 69.4%. The univariate analysis revealed that the age, performance status, B symptoms, Ann Arbor stage, international prognostic index（IPI）, serum LDH and shortterm treatment response were the prognostic factors; multivariate analysis showed that IPI scores and shortterm treatment response had significant effects on the prognosis. Conclusion Most WR-DLBCL patients have stageⅠ-Ⅱdisease and lower tumor burdens, longer survival through chemotherapy and radiotherapy. IPI and short-term treatment response were the independent prognosis factors for WR-DLBCL patients.