老年弥漫大B细胞淋巴瘤患者76例临床疗效和预后分析

Clinical efficacy and prognosis analysis of 76 elderly cases with diffuse large B-cell lymphoma

目的探讨老年弥漫大B细胞淋巴瘤患者的临床疗效及影响预后的相关因素。方法回顾性分析2015年1月至2019年12月复旦大学附属华东医院收治的76例老年(≥60岁)弥漫大B细胞淋巴瘤患者的临床资料。首选R-CHOP方案治疗54例,其余患者因年龄、身体状况、经济因素等原因选择R-miniCHOP、CHOP等方案或支持治疗,未列入疗效分析。采用Kaplan-Meier法分析患者生存情况。采用多因素Cox比例风险模型分析预后相关因素。结果首选R-CHOP方案治疗的54例患者中,完全缓解26例(48.1%),部分缓解14例(25.9%),总有效率为74.1%(40/54);其中,37例60~69岁患者总有效率为70.3%(26/37),17例70~79岁患者总有效率为82.4%(14/17),两组间总有效率差异无统计学意义(χ^(2)=3.01,P=0.390)。76例患者随访1~60个月,至末次随访,49例(64.5%)死亡,中位总生存(OS)时间为16个月,5年OS率为35.5%。Kaplan-Meier法分析显示,初诊年龄≥70岁、美国东部肿瘤协作组(ECOG)评分≥2分、存在B症状、国际预后指数(IPI)评分>3分、乳酸脱氢酶升高、免疫组织化学bcl-2阳性、非生发中心型与不良OS有关(均P<0.05)。多因素Cox回归分析显示,初诊年龄≥70岁、存在B症状、bcl-2阳性、非生发中心型为OS独立危险因素(均P<0.05)。结论老年弥漫大B细胞淋巴瘤患者生存不佳,初诊高龄、有B症状、bcl-2阳性、非生发中心型是预后的独立危险因素。

Objective To investigate the clinical efficacy of elderly patients with diffuse large B-cell lymphoma(DLBCL)and the influencing factors of prognosis.Methods The clinical data of 76 elderly(≥60 years old)patients with DLBCL admitted to Huadong Hospital Affiliated to Fudan University between January 2015 and December 2019 were retrospectively analyzed.The R-CHOP regimen was the preferred treatment for 54 patients,while the remaining patients received R-miniCHOP,CHOP or other regimens or supportive treatments due to age,physical condition,economic factors,etc.,which were not included in the efficacy analysis.Kaplan-Meier method was used to analyze the survival status of patients.Multivariate Cox proportional risk model was used to analyze the prognostic factors.Results Among the 54 patients who preferred R-CHOP regimen for treatment,26 cases(48.1%)achieved complete remission and 14 cases(25.9%)achieved partial remission,and the total effective rate was 74.1%(40/54);Among them,the total effective rate of 37 cases aged 60-69 years was 70.3%(26/37),and the total effective rate of 17 cases aged 70-79 years was 82.4%(14/17);there was no statistically significant difference in the total effective rate between the two groups(χ^(2)=3.01,P=0.390).All 76 patients were followed up for 1-60 months.As of the last follow-up,49 patients(64.5%)died,with the median overall survival(OS)time of 16 months and 5-year OS rate of 35.5%.Kaplan-Meier method showed that age≥70 years old at initial diagnosis,Eastern Cooperative Oncology Group(ECOG)score≥2 points,presence of B symptoms,international prognosis index(IPI)score>3 points,elevated lactate dehydrogenase,immunohistochemistry positive for bcl-2,and non-germinal center type were associated with poor OS(all P<0.05).Multivariate Cox analysis showed that age≥70 years old at initial diagnosis,presence of B symptoms,positive expression of bcl-2,non-germinal center type were independent risk factors for OS(all P<0.05).Conclusions Elderly DLBCL patients have poor survival.Old age at initial diagnosis,B symptoms,bcl-2 positive,and non-germinal center type are independent risk factors of prognosis.