初诊时的严格分期对滤泡细胞淋巴瘤患者预后的影响

Effect of Rigorous Staging at the First Diagnosis on Prognosis of Patients with Follicular Lymphoma

背景:既往研究表明,在早期滤泡细胞淋巴瘤(FL)患者中初诊时接受严格分期的患者,其预后明显优于非严格分期的患者,在国内尚未见相关报道。目的:探讨初诊时严格分期与各期FL患者预后之间的关系。方法:收集和分析2008年到2014年共111名初诊FL患者的临床资料,其中Ⅰ-Ⅱ期患者42名,Ⅲ-Ⅳ期患者69名。严格分期定义为必须满足以下2个必要条件:①骨髓穿刺和骨髓活检;②全身影像学检查(涵盖全身的CT和超声、PET/CT,至少满足1项)。检查不满足任1项即视为非严格的分期。结果:对早期的FL患者,接受严格分期患者的PFS明显优于未经严格分期者(P=0.048)。针对各期FL患者的单因素分析显示,年龄>60岁、LDH升高、骨髓受累、大于3 cm病灶多于3处者,均与不良预后相关。多因素分析表明,年龄、LDH水平、骨髓受累为独立预后因素。结论:对于初治的早期FL患者,接受严格分期者较未接受严格分期者有更好的预后。骨髓是否受累与预后密切相关,临床工作中应重视骨髓状况的评价。

Background：A survey of early stage follicular lymphoma（FL） revealed that the rigorously staged FL patients at first diagnosis had a better outcome as compared with non-rigorous staged FL patients,but there were no similar reports in China.Objective：To explore the relationship between the rigorous staging at first diagnosis and the prognosis of FL patients at different stages.Methods;The clinical data of 111 patients with newly diagnosed FL from 2008 to2014 year were collected and analyzed.The rigorous staging included;（1） bone marrow aspiration and biopsy,（2） imaging examination of whole body including CT and ultrasounic scan,or PET/CT,either or both is defined as rigorous staging,or else as non-rigorous staging.Results：The FL patients at I- II stages by rigorous staging showed a superior progression-free survival（PFS） compared with non-rigorous staging patients（P =0.048）.For all the patients,the age,serum LDH,bone marrow lesion and more than 3 foci of diameter larger than 3 cm correlated with prognosis in univariate analysis,and multivariate analysis revealed that the age,serum LDH and bone marrow imolvement were the independent prognostic factors.Conclusion;Rigorous staging leads to better outcomes,suggesting that accurate and appropriate testing is important for the patients at the first treatment.The close correlation of bone marrow with prognosis indicates that the evaluation of bone marrow is very important for the daily clinical practice.