136例弥漫大B细胞淋巴瘤患者临床预后研究

Study on clinical prognosis of 136 patients with diffuse large B-cell lymphoma

目的探讨影响弥漫大B细胞淋巴瘤(DLBCL)患者预后的危险因素,并着重分析外周血淋巴细胞计数/单核细胞计数(LMR)、LMR/乳酸脱氢酶(LDH)对DLBCL患者预后的参考价值。方法回顾性分析2013年1月至2019年1月贵州医科大学附属医院收治的136例初诊DLBCL患者的临床资料,采用受试者工作特征曲线计算LMR、LMR/LDH最佳截断值,分析不同水平患者[高LMR组(>2.75,64例)、低LMR组(≤2.75,72例)、高LMR/LDH组(>1.12,78例)和低LMR/LDH组(≤1.12,58例)]临床特征的差异;单因素生存分析采用Kaplan-Meier法,多变量生存分析采用Cox回归法。结果与高LMR、LMR/LDH组患者比较,低LMR、LMR/LDH组患者临床分期更晚,一般体能状态评分(ECOG评分)更高,淋巴结结外受累部位数更多,国际预后指数(IPI)评分更高,差异均有统计学意义(P<0.05)。年龄、ECOG评分、瘤灶长径、淋巴结结外受累部位数、临床分期、IPI评分、乙型肝炎表面抗原(HBsAg)、β_(2)-微球蛋白(β_(2)-MG)、利妥昔单抗使用与否、LMR、LMR/LDH对患者3年总体生存(OS)率、无进展生存(PFS)率均具有明显影响,年龄、HBsAg、利妥昔单抗使用与否、LMR/LDH是影响患者3年PFS率、OS率的独立危险因素,差异均有统计学意义(P<0.05)。结论初诊时年龄、HBsAg、利妥昔单抗使用与否、LMR/LDH是DLBCL的独立预后影响因素。

Objective To explore the risk factors affecting the prognosis of the patients with diffuse large B-cell lymphoma(DLBCL),and to mainly analyze the reference value of peripheral blood lymphocytes/monocytes ratio(LMR)and LMR/lactate dehydrogenase ratio(LMR/LDH)on the prognosis of DLBCL.Methods The clinical data of 136 patients with initially diagnosed DLBCL treated in the Affiliated Hospital of Guizhou Medical University from January 2013 to January 2019 were analyzed retrospectively.The optimal cut-off values of LMR and LMR/LDH were calculated by adopting the receiver operating characteristic(ROC)curve.The differences of clinical characteristics were analyzed between different levels of the patients[high LMR group(>2.75),64 cases,low LMR group(≤2.75),72 cases,high LMR/LDH group(>1.12),78 cases]and low LMR/LDH group(≤1.12,58 cases).The Kaplan-Meier method was used for conducting the univariate survival analysis.The Cox regression method was adopted to conduct the multivariables survival analysiss.Results Compared with the high LMR and LMR/LDH groups,the clinical stage in the low LMR and LMR/LDH groups was later,the ECOG score was higher,more involved sites out of lymph nodes and the IPI score was higher,and the differences were statistically significant(P<0.05).The age,ECOG score,long diameter of tumor lesion,number of involvement sites out of lymph node,clinical stage,IPI score,HBsAg,β_(2)-MG,whether using rituximab,LMR and LMR/LDH had significant effects on the 3-year overall survival rate(OS)and 3-year progression-free survival rate(PFS)(P<0.05).The age,HBsAg,whether using rituximab and LMR/LDH were the independent risk factors affecting 3-year PFS and OS in the patients with DLBCL(P<0.05).Conclusion The age at initial diagnosis,HBsAg,whether using rituximab and LMR/LDH are the independent poor prognostic factors for DLBCL(P<0.05).