基于HALP评分对弥漫大B细胞淋巴瘤预后的评估分析

Evaluation analysis of prognosis in diffuse large B-cell lymphoma based on HALP score

目的探讨化疗前血红蛋白、白蛋白、淋巴细胞、血小板组成的HALP评分在弥漫大B细胞淋巴瘤(DLBCL)患者中的预后评估价值。方法回顾性分析2015年1月至2022年10月在该院初诊的DLBCL患者临床资料及化疗前的实验室指标,采用X-tile软件计算HALP评分最佳截断值,根据最佳截断值进行分组,采用χ2检验分析不同HALP评分组临床特征构成比的差异,采用Kaplan-Meier法绘制不同评分组间无进展生存(PFS)时间、总生存(OS)时间的生存曲线,采用Cox单因素和多因素回归模型分析DLBCL患者的预后影响因素,使用受试者工作特征(ROC)曲线评估HALP评分对DLBCL患者PFS时间、OS时间的预测能力。结果共纳入132例DLBCL患者,HALP评分的最佳截断值为21.23分,低HALP评分组54例,高HALP评分组78例。低HALP评分组与更晚的临床分期、更高的国际预后指数(IPI)和美国国立综合癌症网络(NCCN)-IPI评分、更高的乳酸脱氢酶(LDH)水平、更低的总体有效率(ORR)相关(P<0.05)。低HALP评分组与高HALP评分组相比PFS时间和OS时间更短(P<0.05)。Cox单因素和多因素回归模型分析结果显示HALP评分≤21.23分是影响PFS时间的独立危险因素(HR=1.811,P=0.031)。ROC曲线结果提示HALP评分联合IPI评分或NCCN-IPI评分比单用IPI评分、NCCN-IPI评分对DLBCL患者PFS、OS时间的预测价值更高。结论HALP评分与DLBCL患者的预后相关,可早期识别预后不良的高危DLBCL患者,HALP评分与IPI评分、NCCN-IPI评分联合评估时预测价值更高。

Objective To investigate the prognostic evaluation value of the HALP score composed of hemoglobin,albumin,lymphocytes and platelets before chemotherapy in the patients with diffuse large B-cell lymphoma(DLBCL).Methods The clinical data and laboratory indicators before chemotherapy in the patients with DLBCL newly diagnosed in this hospital from January 2015 to October 2022 were retrospectively analyzed.The optimal cut-off value of HALP was calculated by X-tile software.The patients were grouped according to the optimal cutoff value,the Chi-square test was used to analyze the difference in the constituent ratio of clinical characteristics among different HALP score groups,the survival curves of the progression-free survival(PFS)time and overall survival(OS)time among the groups with different scores were drawn by using the Kaplan-Meier method,the Cox univariate and multivariate analysis regression model was adopted to analyze the prognostic influencing factors in DLBCL patients,and the predictive ability of HALP score for PFS time and OS time in DLBCL patients was evaluated by using the receiver operating characteristic(ROC)curve.Results A total of 132 patients with DLBCL were included,the optimal cutoff value of HALP score was 21.23 points.There were 54 cases in the low HALP score group and 78 cases in the high HALP score group.The low HALP score group was correlated with the later clinical stage,higher IPI and NCCN-IPI scores,higher LDH level and lower overall response rate(ORR)(P<0.05).Compared to the high HALP score group,the PFS time and OS time in the low HALP score group were shorter(P<0.05).The Cox univariate and multivariate regression model analysis results indicated that the HALP score≤21.23 points was an independent risk factor affecting the PFS time(HR=1.811,P=0.031).The ROC curve results suggested that the combination of HALP score combined with IPI score or NCCN-IPI score had higher predictive value for PFS time and OS time in DLBCL patients compared to use IPI or NCCN-IPI alone.Conclusion The HALP score is correlated with the prognosis of DLBCL patients,and could early identify the high-risk DLBCL patients with poor prognosis.The HALP score,IPI score and NCCN-IPI score combined evaluation has higher predictive value.