年轻弥漫大B细胞淋巴瘤患者的临床病理特征与预后分析

Analysis of Clinical Pathological Features and Prognosis in Young Patients with Diffuse Large B Cell Lymphoma

目的:探讨弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)患者的临床病理特征及其对预后评估作用。方法:选取本院2013年1月至2017年5月177例确诊为弥漫大B细胞淋巴瘤的初治患者,回顾性分析其临床病理特征及其对预后的影响。结果:单因素预后分析发现,分期Ⅲ-Ⅳ期(P=0.004,P=0.029)、ECOG评分2-4分(P=0.003,P=0.042)、结外受累> 1处(P=0.000,P=0.031)、异常升高的LDH值(P=0.000,P=0.046)为影响患者OS与PFS的危险因素;B症状(P=0.020)、异常升高的β2-MG值(P=0.020)仅影响患者OS。COX多因素分析显示,异常升高的β2-MG值(P=0.044)及分期(P=0.046)为影响患者OS的独立危险因素,分期(P=0.029)是影响患者PFS的独立因素。年龄调整的IPI(aaIPI)评分2-3分的患者与初治骨髓受累的患者OS(P=0.000,P=0.000)与PFS(P=0.013,P=0.000)更差。结论:异常升高的β2-MG值是影响弥漫大B细胞淋巴瘤患者OS的独立因素,分期是影响患者OS与PFS的独立因素。aaIPI评分2-3分患者与初治骨髓受累的患者OS与PFS更差。

Objective:To explore the clinical pathological features of the patients with diffuse large B cell lymphoma(DLBCL)and their prognostic factors.Methods:The prognosis of the clinical pathological features and their influence on prognosis of 177 patients diagnosed as DLBCL at the first visit from January 2013 to May 2017 in our hospital were analyzed retrospectively.Results:The univariate analysis showed that overall survival(OS)and progression-free survival(PFS)were associated with later Ann Arbor stage(Ⅲ-Ⅳ)(P<0.01,P<0.05),high performance status(ECOG score2-4)(P<0.01,P<0.05),extranodal involvement>1(P<0.01,P<0.05),elevated LDH level(P<0.01,P<0.05).B symptom(P<0.05)and elevatedβ2-MG level(P<0.05)also influenced OS.COX multivariate analysis showed that the elevatedβ2-MG level(P<0.05)and later stage(Ⅲ-Ⅳ)(P<0.05)have an independent influence on OS,later stage(Ⅲ-Ⅳ)(P<0.05)also independently influenced PFS.The patients with high aaIPI score(2-3)and bone marrow involvement before treatment had poor OS(P<0.01,P<0.01)and PFS(P<0.05,P<0.01).Conclusion:Elevatedβ2-MG level can independently influence OS,and later stage(Ⅲ-Ⅳ)can independently influence both OS and PFS.High aaIPI score(2-3)and bone marrow involvement before treatment have an inferior influence on OS and PFS.