CLL-IPI评分系统在中国慢性淋巴细胞白血病患者中的预后评估价值

Prognostic significance of CLL-IPI for Chinese patients with chronic lymphocytic leukemia

目的明确慢性淋巴细胞白血病国际预后指数（CLL-IPI）评分系统在中国慢性淋巴细胞白血病（CLL）患者中的预后评估价值。方法回顾性分析2002年1月至2017年11月诊断的215例初治CLL患者的临床资料，采用CLL-IPI评分系统进行危险分层和预后评估。结果①215例患者中，男143例，女72例，中位年龄60（16~85）岁。中位无治疗生存（TFS）和中位总生存（OS）时间分别为16（4~24）个月和180（145~215）个月。②按照CLL-IPI评分系统进行危险分层，低危组（60例）、中危组（50例）、高危组（45例）及极高危组（60例）的中位TFS时间分别为56、15、12及5个月，差异有统计学意义（P〈0.001）。③中位随访48（1~192）个月，低危组、中危组、高危组及极高危组的中位OS时间分别为未达到和180、89、74个月，预计5年OS率分别为97.6%、83.7%、67.8%及55.2%，差异有统计学意义（P〈0.001）。④多因素分析结果显示，免疫球蛋白重链可变区（IGHV）基因无突变（P=0.038）、β2微球蛋白〉3.5 mg/L（P〈0.001）是影响患者TFS的独立危险因素；而TP53缺失和（或）突变（P=0.008）、IGHV基因无突变（P=0.017）、年龄〉65岁（P=0.045）是影响患者OS的独立危险因素。结论CLL-IPI评分系统在中国初治CLL患者中具有较好的预后判断意义，可作为CLL有效的预后分层工具。

ObjectiveTo validate the prognostic value of chronic lymphocytic leukemia-international prognostic index （CLL-IPI） for Chinese CLL patients.MethodsTwo hundred and fifteen CLL patients who were initially diagnosed and treated in Jiangsu Province Hospital from January 2002 to November 2017 were included in the retrospective analysis. Risk stratification and prognosis were evaluated by CLL-IPI scoring system.Results①Of the 215 patients, 143 were males and 72 were females, with a median age of 60 （16-85） years old. The median treatment-free survival （TFS） and overall survival （OS） was 16 months （4-24 months） and 180 months （145-215 months）, respectively. ② The median TFS for low （n=60）, intermediate （n=50）, high （n=45） and very high risk group （n=60） according to the CLL-IPI scoring system was 56, 15, 12 and 5 months, respectively （P〈0.001）. ③ The median follow-up was 48 months （1-192 months）. The median OS for low risk group was not reached and for intermediate, high, and very high risk group was 180, 89 and 74 months, respectively. The estimated 5-year OS rate was 97.6%, 83.7%, 67.8% and 55.2%, respectively （P〈0.001）. ④ Multivariate analysis indicated that unmutated immunoglobulin heavy chain variable region （IGHV） gene and β2-microglobulin〉3.5 mg/L（P〈0.001） were independent prognostic factors of TFS, while TP53 deletion and/or mutation（P=0.008）, unmutated IGHV （P=0.017） and age〉65 years（P=0.045） were independent prognostic factors of OS.ConclusionCLL-IPI is the powerful tool for risk stratification in Chinese CLL patients.