外周血淋巴细胞绝对计数对外周T细胞淋巴瘤-非特指型患者的预后价值

Prognostic value of peripheral blood absolute lymphocyte count for patients with peripheral T-cell lymphoma,not otherwise specified

目的探讨外周血淋巴细胞绝对计数(ALC)在外周T细胞淋巴瘤-非特指型(PTCL-NOS)患者中的预后意义。方法回顾性分析2008年1月至2016年1月天津市人民医院收治的69例初治PTCL-NOS患者的临床资料,分析ALC水平与患者临床特征、疗效及预后的关系。结果69例患者中,低ALC(<1.0×109/L)23例(33.3%),高ALC(≥1.0×109/L)46例(66.7%)。与高ALC组比较,低ALC组国际预后指数(IPI)及PTCL-NOS预后指数(PIT)评分较高,临床分期较晚,多伴乳酸脱氢酶水平升高(均P<0.05)。低ALC组总有效率为56.5%(13/23),低于高ALC组的67.4%(31/46),但差异无统计学意义(χ^2=0.784,P=0.376);低ALC组3年生存率低于高ALC组,差异有统计学意义(40.5%比68.6%,χ^2=7.846,P=0.010)。单因素分析显示,美国东部肿瘤协作组体能状态评分≥2分、IPI评分≥2分、AnnArbor分期Ⅲ~Ⅳ期及ALC<1.0×109/L为预后不良因素(均P<0.05);Cox多因素分析显示,AnnArbor分期Ⅲ~Ⅳ期和ALC<1.0×109/L为独立预后不良因素(P=0.008,P=0.029)。结论PTCL-NOS患者初诊时外周血ALC降低提示预后不良,可作为PTCL-NOS患者预后评估的新指标。

Objective To explore the prognostic value of peripheral blood absolute lymphocyte count (ALC) for patients with peripheral T-cell lymphoma,not otherwise specified (PTCL-NOS).Methods The clinical data of 69 patients with PTCL-NOS treated in Tianjin Union Medical Center from January 2008 to January 2016 were analyzed retrospectively.The relationship between different levels of ALC and clinical characteristics,therapeutic efficacy and prognosis was analyzed.Results Among 69 patients,23 cases (33.3%) had low ALC (<1.0×109/L),and 46 cases (66.7%) had high ALC (≥1.0×109/L).Compared with the high ALC group,the low ALC group showed the higher International Prognostic Index (IPI) and PTCL-NOS Prognostic Index (PIT) scores,advanced clinical stage and higher lactate dehydrogenase level (all P < 0.05).The total efficacy rate in the low ALC group was lower than that in the high ALC group [56.5%(13/23) vs.67.4%(31/46)],but the difference was not statistically significant (χ^2 = 0.784,P = 0.376).The 3-year survival rate in the low ALC group was significantly lower than that in the high ALC group,and the difference was statistically significant (40.5% vs.68.6%,χ^2 = 7.846,P = 0.010).Univariate analysis showed that the US Eastern Cooperative Oncology Group performance status score≥2,IPI score≥2,Ann Arbor stage Ⅲ-Ⅳ and ALC<1.0×109/L were the poor prognostic factors (all P < 0.05),while Cox multivariate analysis showed that the Ann Arbor stage Ⅲ-Ⅳ and ALC<1.0×109/L were the independent risk factors for prognosis of patients with PTCL-NOS (P = 0.008,P = 0.029).Conclusion The decrease of peripheral blood ALC in patients with PTCL-NOS at the initial diagnosis suggests a poor prognosis,and ALC can be used as a new indicator for prognosis evaluation of PTCL-NOS patients.