老年弥漫大B细胞淋巴瘤预后的相关影响因素探讨

Research on the Prognosis-related Factors of Elderly Patients with Diffuse Large B-cell Lymphoma

【目的】探讨影响老年弥漫大B细胞淋巴瘤（DLBCL）患者的预后相关因素。【方法】通过分析2009年1月至2014年12月本院血液科收治的70例老年DLBCL患者的性别、年龄、Ann-Arbor分期、B症状、体能状态ECOG评分、血清乳酸脱氢酶（LDH）、国际预后评分指数（IPI）、骨髓浸润等临床资料,探讨上述指标与预后的相关性,并比较R-CHOP与CHOP两种方案患者的生存情况。【结果】70例老年DLBCL患者的中位生存期41.67个月,2年OS 率69.2%。单因素分析显示：年龄、Ann Arbor分期、ECOG 评分、IPI评分、治疗前LDH值、骨髓浸润、治疗方案均与预后有关（P〈0.05）;COX回归多因素分析表明：ECOG 评分、IPI评分、骨髓浸润、化疗方案是影响老年DLBCL患者预后的独立危险因素（P〈0.01）。【结论】ECOG 评分、IPI评分、骨髓浸润、化疗方案是影响老年DLBCL患者预后的独立危险因素;R-CHOP方案较CHOP方案疗效好,能够改善患者生存。

【Objective】To discuss the prognosis-related factors of elderly patients with diffuse large B-cell lymphoma （DLBCL）. 【Methods】We retrospectively analyzed the clinical data from 70 cases of elderly patients with initial diffuse large B-cell lymphoma from January 2009 to December 2014. The parameters included gender, age, Ann-Arbor staging, B symptoms, ECOG score of performance status （ECOG-PS）, serum level of lactate dehydrogenase （LDH）, international prognostic index （IPI） and bone marrow invasion. We also compared the survival of patients who received CHOP chemotherapy and R-CHOP chemotherapy.The correlation between these indexes and prognosis was analyzed. 【Results】The median survival of all 70 cases of elderly patients with DLBCL was 41.67 months and the OS rate of 2 years was 69.2%. Single factor analysis showed that age, Ann-Arbor staging, bone marrow involvement, ECOG score, IPI score, value of LDH before treatment and therapeutic regimen were all related with prognosis （P〈0.05 or P〈0.01）. COX regression multiple-factor analysis indicated that ECOG score、IPI score、bone marrow invasion and chemotherapy were the independent factors for predicting the prognosis of the elderly patients with DLBCL （P〈0.01）. 【Conclusion】ECOG score、IPI score、bone marrow invasion and chemotherapy were independent predictive and prognostic factors in elderly patients with DLBCL. R-CHOP chemotherapy has more advantages than CHOP chemotherapy in improving prognosis of elderly patients with DLBCL.