儿童非霍奇金淋巴瘤的预后因素分析

Analysis of prognostic factors in children with non-Hodgkin' s lymphoma

目的:研究儿童非霍奇金淋巴瘤(NHL)的预后影响因素。方法:纳入2012年1月到2022年12月期间我院小儿血液内科收治的初发NHL患者108例,收集病历资料;采用寿命表法计算5年总生存率(OS)、无进展生存率(PFS),用Cox比例风险模型对预后影响因素进行分析。结果:108例NHL患儿中,男女比例2.72∶1,平均年龄为7.82岁。所有患儿均接受规范化疗,其中死亡21例,复发/进展24例,5年累积OS 79.0%,累积PFS 71.0%。单因素分析显示,中枢神经系统侵犯、乳酸脱氢酶(LDH)、D-二聚体、中性粒细胞与淋巴细胞比值(NLR)、预后营养指数(PNI)等因素影响患儿的预后;多因素分析显示,LDH、D-二聚体、PNI为独立的预后因素。由LDH、D-二聚体、PNI构建危险评分模型,危险评分高值组的生存率明显低于低值组。结论:目前儿童非霍奇金淋巴瘤化疗效果良好,LDH、D-二聚体、PNI是儿童非霍奇金淋巴瘤独立的预后因素,并且由LDH、D-二聚体、PNI计算得来的危险评分可用于儿童NHL的预后评估。

Objective:To investigate the prognostic factors of children with non-Hodgkin's lymphoma(NHL).Methods:One hundred and eight patients with newly-diagnosed childhood NHL in our hospital from January 2012 to December 2022 were selected,and the medical records were collected.The life-table method was used to calculate the 5-year overall survival(OS)and progression-free survival(PFS),and the Cox proportional hazards model was used to analyze the prognostic factors.Results:Among the 108 children with NHL,the male to female ratio was 2.72∶1,and the mean age was 7.82 years.All children received standardized chemotherapy.The outcome included 21 deaths and 24 relapses/progressions,with a 5-year cumulative OS of 79.0%and a cumulative PFS of 71.0%.Univariate analysis showed that central nervous system invasion,LDH,D-dimer,neutrophil-to-lymphocyte ratio(NLR),and prognostic nutritional index(PNI)affected the prognosis of the children,while multivariate analysis showed that LDH,D-dimer,and PNI were independent prognostic factors.Risk scores were calculated by LDH,D-dimer,and PNI,and the survival rate was significantly lower in the high hazard score group than in the low hazard score group.Conclusion:Current chemotherapy strategies show favorable outcomes in children's NHL,LDH,D-dimer,and PNI are independent prognostic factors in such patients,and risk scores calculated by LDH,D-dimer,and PNI can be used for prognostic evaluation of pediatric NHL.