老年与年轻艾滋病相关淋巴瘤病人临床特点及预后分析

Clinical characteristics and prognostic analysis of elderly and young patients with AIDS-related lymphoma

目的 回顾性分析老年与年轻艾滋病相关淋巴瘤(AIDS-related lymphoma, ARL)病人的临床特点及预后影响因素。方法 收集2009—2023年在南京市第二医院诊治的55例病人的病例资料,并采用Cox回归分析影响病人总生存时间(OS)的因素。结果 根据年龄是否≥60岁,将所有病人分为老年组15例和年轻组40例。年轻组病人较老年组病人易合并B组症状(P=0.009)。随访至2023年8月31日,老年组死亡率为53.3%(8/15),中位OS为14.3个月,年轻组死亡率为47.5%(19/40),中位OS为13.4个月,2组间死亡率(P=0.700)及OS(P=0.872)差异均无统计学意义。单因素分析显示,老年组中接受标准化疗是预后的影响因素(P=0.010)。年轻组中IPI评分(P=0.015)、CD4~+T淋巴细胞计数(P=0.039)、B组症状(P=0.016)、丙肝抗体阳性(P=0.025)、标准化疗(P=0.011)是预后的影响因素;多因素Cox回归分析结果显示,IPI评分是影响年轻病人预后的独立危险因素(P=0.042)。结论 ARL多为B细胞来源淋巴瘤,大多数属于中高危病人,病死率高,年轻病人中IPI评分是影响其预后的关键因素,所有年龄段病人都需严格接受标准化疗,改善预后。

Objective To compare the clinical characteristics and prognosis of AIDS-related lymphoma(ARL)between the elderly patients and the young patients.Methods This study retrospectively enrolled 55 patients with newly diagnosed ARL from 2009 to 2023 in our hospital.According to the quantitative and qualitative data,the factors affecting the overall survival time(OS)were analyzed by Cox regression.Results All the patients were divided into elderly group(15 cases,aged≥60 years)and young group(40 cases,aged<60 years).Compared with the elderly patients,the young patients were prone to presenting with the symptoms of group B(P=0.009).All patients were followed up until August 31,2023,and the mortality rate and median OS of the elderly patients was 53.3%(8/15)and 14.3 months,compared with 47.5%(19/40)and 13.4 months in the young patients.There were no significant differences in mortality(P=0.700)and OS(P=0.872)between the two groups.Univariate survival analysis revealed that standardized therapy(P=0.010)affected the prognosis of elderly patients,and IPI score(P=0.015),CD4+T cell count(P=0.039),group B symptoms(P=0.016),hepatitis C antibody(P=0.025),standardized treatment(P=0.011)were associated with OS in young group.Multiple survival analysis showed that IPI score(P=0.042)was the independent risk factor affecting the prognosis of young patients.Conclusions B-cell lymphoma is the main type of ARL,and most of them show high risk of death.All the patients should receive standardized treatment to improve prognosis.