体质指数对套细胞淋巴瘤预后的影响

Effect of Body Mass Index on the Prognosis of Mantle Cell Lymphoma

目的:探讨不同的体质指数(BMI)与套细胞淋巴瘤(MCL)预后的相关性。方法:回顾性分析福建医科大学附属协和医院收治的108例套细胞淋巴瘤患者的临床特征、生物学指标,分析不同的BMI对MCL患者总生存期(OS)和无进展生存期(PFS)的影响。进一步观察BMI与B症状、LDH及Ki-67指数的相关性,以及BMI在自体外周血造血干细胞移植(Auto-PBSCT)和常规化疗组中的差异。结果:108例患者确诊时中位年龄59(25-79)岁,男女比例是4.4∶1。Ann Arbor分期Ⅲ-Ⅳ期患者占88.89%,骨髓累及者占63.89%,脾脏浸润者占49.07%。以BMI≥24 kg/m^(2)为临界值将患者分为高BMI组和低BMI组两组。低BMI组的5年PFS和OS率分别为31.9%和47.0%,高BMI组的5年PFS和OS率分别为64.6%和68.7%。与低BMI组相比,高BMI组的死亡发生率更低(P<0.01)。在多变量分析中,BMI是PFS的独立预测因素(HR=0.282;95%CI:0.122-0.651;P=0.003),也是OS的独立预测因素(HR=0.299;95%CI:0.129-0.693;P=0.005)。同时,存在B症状的患者的BMI低于无B症状的患者(P=0.01),但BMI对患者LDH和Ki-67没有影响。16例患者行Auto-PBSCT,且预后较常规化疗组明显好转,BMI在Auto-PBSCT组和常规化疗组未见明显差异。结论:BMI是套细胞淋巴瘤患者PFS和OS的独立预后因素,可能受B症状对BMI的影响。

Objective:To explore the correlation between different body mass index(BMI)and prognosis of mantle cell lymphoma(MCL).Methods:The clinical characteristics and biological indices of 108 patients with MCL treated in Fujian Medical University Union Hospital were retrospectively analyzed,and the effects of different BMI on overall survival(OS)and progression-free survival(PFS)were analyzed.The correlation between BMI and B symptoms,LDH and Ki-67 was further observed.Furthermore,the differences of BMI between Autologous peripheral blood stem cell transplantation(Auto-PBSCT)and conventional chemotherapy groups were explored.Results:Among 108 patients,the median age at diagnosis was 59(25-79)years old,and the male to female ratio was 4.4∶1.88.89%of patients with Ann Arbor staging III-IV,63.89%with bone marrowinvolvement,and 49.07%with splenic infiltration.Patients with BMI≥24 kg/m^(2)were divided into two groups:the high BMI group and the lowBMI group.The 5-year PFS and OS of patients in the lowBMI group were 31.9%and 47.0%,respectively,while those in the high BMI group were 64.6%and 68.7%,respectively.The incidence of death in the high BMI group was lower than that of the lowBMI group(P<0.01).In multivariate analysis,BMI was an independent predictor of PFS(HR=0.282;95%CI:0.122-0.651;P=0.003)and an independent predictor of OS(HR=0.299;95%CI:0.129-0.693;P=0.005).Also,patients with B symptoms had a lower BMI than those without B symptoms(P=0.01),but BMI had no effect on patients′LDH and Ki-67.The prognosis of 16 patients treated with Auto-PBSCT was significantly better than that of the conventional chemotherapy group.There was no significant difference in BM I between Auto-PBSCT group and conventional chemotherapy group.Conclusion:BMI is an independent prognostic factor for PFS and OS in MCL,and may be influenced by the effect of B symptoms on BMI.