弥漫大B细胞淋巴瘤患者预后因素的研究进展

Research progress of prognostic factors in diffuse large B-cell lymphoma patients

弥漫大B细胞淋巴瘤(DLBCL)是成年人侵袭性非霍奇金淋巴瘤(NHL)中最常见类型, 近年来发病率呈上升趋势。DLBCL患者的分子生物学异常和组织形态学改变具有高度异质性, 因此其预后相关因素较多。国际预后指数(IPI)、细胞来源(COO)等被广泛应用于DLBCL患者预后评估, 而循环游离DNA(cfDNA)的动态变化、外周血中维生素D或者白蛋白水平、系统性炎症等具有潜在预测价值的评估方法亦逐步成为国内、外研究热点。IPI是单纯化疗时代基于患者临床特征的预后评估方法, 简单易行。但是, 进入免疫治疗及靶向治疗时代, IPI评估患者预后的准确性不断受到冲击。COO可更为精准地识别患者疾病类型, 但是较高的标本质量要求和昂贵的检测费用限制了其应用。对于cfDNA、维生素D、白蛋白、相关炎性指标水平, 通过外周血即可获取标本进行检测, 操作简便、经济, 可以弥补IPI和COO等方法的不足。笔者拟就DLBCL相关预后因素的研究进展进行总结, 旨在为指导临床选择最佳预后评价方法提供理论依据。

Diffuse large B-cell lymphoma recent years(DLBCL)is the most common type of aggressive non-Hodgkin lymphoma(NHL)in adults,and its incidence has increased in recent years.DLBCL patients'abnormality of molecular biology and change of histomorphology have high heterogeneity,so their prognostic factors are diverse.Prognostic evaluation standard of DLBCL patients,such as International Prognostic Index(IPI)and cell of origin(COO)were widely used,and the evaluation method that have potential predictive value,such as dynamic changes of circulating free DNA(cfDNA),vitamin D or albumin in peripheral blood,and systemic inflammation have become a research hotspot in China and abroad.IPI is a prognosis evaluation based on the clinical characteristics of patients in the era of simple chemotherapy,which is simple and easy to operate.However,in the era of immunotherapy and targeted therapy,the accuracy of IPI in evaluating patients'prognosis is constantly impacted.COO can identify the disease type of patients more accurately,but higher sample requirements and expensive testing costs limit its application,while the level of cfDNA,vitamin D,albumin,and related inflammatory indicators can be obtained from peripheral blood samples for detection,and are easy to operate and economical,can make up for the shortcomings of IPI and COO.This article reviews research progress of DLBCL related prognostic factors to provide a theoretical basis for guiding the selection of the best prognostic evaluation method in clinical work.