初治霍奇金淋巴瘤患者临床病理特征及预后影响因素分析

ANALYSIS OF CLINICOPATHOLOGICAL CHARACTERISTICS AND PROGNOSTIC FACTORS OF NEWLY DIAGNOSED HODGKIN’S LYMPHOMA PATIENTS

目的探讨初治霍奇金淋巴瘤患者临床病理特征及预后影响因素。方法选择2013年1月—2018年12月收治的56例初治霍奇金淋巴瘤(HL)患者作为研究对象,分析其临床病理特征,所有患者随访截止至2019年12月,采用Kaplan-Meier法进行生存分析,统计总生存期(OS),采用Log-rank检验及多因素COX逐步回归模型分析预后影响因素。结果初治霍奇金淋巴瘤患者中位年龄为38岁(8~72岁),其中年龄≥60岁患者16例,约占28.57%;Ann Arbor分期:Ⅰ~Ⅱ期24例(42.86%)、Ⅲ~Ⅳ期32例(57.14%);24例患者血红蛋白降低,约占42.86%;28例患者β2-微球蛋白异常,约占50%;IPS 0~3分(低中危)患者48例(85.71%)、霍奇金淋巴瘤国际预后评分(IPS)≥4分(高危)患者8例(14.29%);LDH升高患者29例,约占51.79%;伴有B症状29例(51.79%)、伴脾大者16例(28.57%)、合并淋巴结外浸润21例(37.5%);病理分型:经典型霍奇金淋巴瘤51例(91.07%)、结节性淋巴细胞为主的霍奇金淋巴瘤5例(8.93%);≥3个淋巴结区域受累51例(91.07%);纵膈巨大肿块4例(6.45%)。56例患者CR32例、PR18例、SD4例、PD2例,总有效率为89.29%。患者中位随访时间为42个月(8~80个月),2、3年总体生存率分别为94.64%(53/56)和91.07%(51/56)。单因素及多因素COX逐步回归模型分析显示,年龄≥60岁、血红蛋白降低、β2-微球蛋白异常、IPS≥3分、LDH升高是导致初治霍奇金淋巴瘤3年生存率下降的独立危险因素。结论初治霍奇金淋巴瘤好发青年男性,临床预后较好,年龄≥60岁、、β2-微球蛋白异常、IPS≥3分、血清乳酸脱氢酶升高是导致初治霍奇金淋巴瘤3年生存率下降的独立危险因素,据此进行患者危险度分层,有助于指导临床治疗及预测初治HL预后。

Objective To explore the clinicopathological characteristics and prognostic factors of newly Diagnosed Hodgkin’s Lymphoma Patients.Methods Fifty six newly Diagnosed Hodgkin’s Lymphoma Patients met the inclusion criteria from January 2013 to December 2018 were selected as the study subjects, which clinicopathological characteristics were analyzed, and all the patients had been followed up by telephone andoutpatient review until December 2019.The Kaplan-Meier method was used for survival analysis.The total survival time(OS) was counted.Log-rank test and multi-factor COX stepwise regression model were used to analyze the prognostic factors.Results The median age of newly Diagnosed Hodgkin’s Lymphoma Patients was 38 years old(8~72 years old),including 16 patients aged≥60 years old, accounting for about 28.57%;Ann Arbor staging: 24 cases(42.86%) of Ⅰ~Ⅱstage, 32 cases(57.14%) of Ⅲ~Ⅳstage;24 patients with hemoglobin decrease, accounting for 42.86%;28 patients with β2-microglobulin abnormalities, accounting for about 50%;48 patients(85.71%) with IPS 0~3 points(low and intermediate risk),and 8 patients(14.29%) with Hodgkin lymphoma international prognostic score(IPS) ≥4 points(high risk);29 patients with elevated LDH,accounting for about 51.79%;29 patients with B symptoms(51.79%),16 patients with splenomegaly(28.57%),21 patients with extra-lymph node infiltration(37.5%);pathological classification: 51 patients(91.07%) was classical Hodgkin’s lymphoma, 5 patients(8.93%) was Nodular lymphocyte-based Hodgkin lymphoma;51 patients(91.07%) involving ≥3 lymph node areas;4 patients(6.45%) with huge mediastinum.There were 32 patients of CR,18 patients of PR,4 patients of SD,and 2 patients of PD in 56 patients.The total effective rate was 89.29%.The median follow-up time of the patients was 42 months(8 to 80 months),and the overall survival rates at 2 and 3 years were 94.64%(53/56) and 91.07%(51/56),respectively.Univariate analysis and Multivariate COX stepwise regression model analysis showed that age≥60 years old, hemoglobin decrease, β2-microglobulin abnormalities, IPS≥3 points, and elevated LDH are the reasons for the 3~year survival of newly treated Hodgkin lymphoma The independent risk factor of the decline rate.Conclusion newly Diagnosed Hodgkin’s Lymphoma Patients mostly occurs in young men, more likely to have a good clinical prognosis, age ≥60 years, hemoglobin decrease, β2-microglobulin abnormalities, IPS ≥3 points, serum lactate dehydrogenase rise High is an independent risk factor that leads to a decrease in the 3~year survival rate of newly diagnosed Hodgkin lymphoma.Based on this, stratification of patient risk can help guide clinical treatment and predict the prognosis of newly Diagnosed Hodgkin’s Lymphoma Patients.