老年弥漫大B细胞淋巴瘤患者的临床特征及预后分析

Clinical characteristics and prognosis of diffuse large B cell lymphoma in the elderly

目的分析老年弥漫大B细胞淋巴瘤(DLBCL)患者的临床病理特征,并探究各临床病理特征对老年DLBCL患者预后的影响,比较CHOP方案与利妥昔单抗联合CHOP(R-CHOP)方案治疗的疗效差异。方法收集2010年1月-2017年12月新疆医科大学附属肿瘤医院收治的122例老年DLBCL患者的临床病理资料,采用生存分析及多因素逐步cox回归分析探索影响老年DLBCL患者的预后因素。采用χ2检验对CHOP组与R-CHOP组进行疗效对比。结果122例患者的中位生存时间为29.6个月,1年、2年、3年总生存(OS)率分别为74.11%、54.05%、48.21%。老年DLBCL患者的预后与Ann Arbor分期、最大肿块直径、体能状态ECOG评分、国际预后评分指数(IPI)、治疗前乳酸脱氢酶(LDH)水平、细胞起源及治疗方案有关(P<0.05)。Ann Arbor分期、ECOG评分、细胞起源及治疗方案为影响老年DLBCL患者预后的独立影响因素。CHOP组CR率为44.1%,R-CHOP组CR率为64.8%,R-CHOP组的总有效率及CR率均优于CHOP组(P<0.05)。结论老年DLBCL具有初诊时症状不典型、肿瘤分期晚、化疗耐受性差等特点;R-CHOP方案能显著改善老年DLBCL患者的预后。

ObjectiveTo analyze the clinicopathological features of elderly patients with diffused large B-cell lymphoma,and to explore the effect of clinicopathological features on the prognosis of elderly patients with DLBCL,and to compare the efficacy of CHOP regimen and rituximab combined with CHOP regimen.MethodsThe clinicopathological data were retrieved of 122 elderly DLBCL patients admitted to the Affiliated Tumor Hospital of Xinjiang Medical University from January 2010 to December 2017 retrospectively.the survival analysis and multivariate stepwise cox regression analysis were used to explore the prognostic factors of elderly DLBCL patients.Chi-square test was used to compare the efficacy of CHOP group with R-CHOP group.ResultsThe median survival time of 122 patients was 29.6 months.The overall survival(OS)rates of 1,2 and 3 years were 74.11%,54.05%and 48.21%,respectively.The prognosis of elderly DLBCL patients was associated with Ann Arbor stage,maximum mass diameter,ECOG score of physical condition,International Prognosis Index(IPI),level of lactate dehydrogenase(LDH)before treatment,cell origin and treatment plan(P<0.05).Ann Arbor stage,ECOG score,cell origin and treatment regimen were independent factors affecting the prognosis of elderly DLBCL patients.The CR rate of CHOP group was 44.1%,and that of R-CHOP group was 64.8%.The total effective rate and CR rate of R-CHOP group were significantly better than those of CHOP group(P<0.05).Conclusion Old patients with DLBCL were shown to present with atypical symptoms at first diagnosis,late staging of tumors and poor tolerance to chemotherapy.R-CHOP regimen was shown to be able to significantly improve the prognosis of elderly patients with DLBCL.