Identifying relevant factors influencing cancer-related fatigue in patients with diffuse large B-cell lymphoma during chemotherapy

BACKGROUND Diffuse large B-cell lymphoma(DLBCL)is a rapidly growing malignant tumor,and chemotherapy is one of the treatments used to combat it.Although advancements of science and technology have resulted in more and more patients being able to receive effective treatment,they still face side effects such as fatigue and weakness.It is important to thoroughly investigate the factors that contribute to cancer-related fatigue(CRF)during chemotherapy.AIM To explore the factors related to CRF,anxiety,depression,and mindfulness levels in patients with DLBCL during chemotherapy.METHODS General information was collected from the electronic medical records of eligible patients.Sleep quality and mindfulness level scores in patients with DLBCL during chemotherapy were evaluated by the Pittsburgh Sleep Quality Index and Five Facet Mindfulness Questionnaire-Short Form.The Piper Fatigue Scale was used to evaluate the CRF status.The Self-Rating Anxiety Scale and Self-Rating Depression Scale were used to evaluate anxiety and depression status.Univariate analysis and multivariate regression analysis were used to investigate the factors related to CRF.RESULTS The overall average CRF level in 62 patients with DLBCL during chemotherapy was 5.74±2.51.In 25 patients,the highest rate of mild fatigue was in the cognitive dimension(40.32%),and in 35 patients the highest moderate fatigue rate in the behavioral dimension(56.45%).In the emotional dimension,severe fatigue had the highest rate of occurrence,34 cases or 29.03%.The CRF score was positively correlated with cancer experience(all P<0.01)and negatively correlated with cancer treatment efficacy(all P<0.01).Tumor staging,chemotherapy cycle,self-efficacy level,and anxiety and depression level were related to CRF in patients with DLBCL during chemotherapy.CONCLUSION There was a significant correlation between CRF and perceptual control level in patients.Tumor staging,chemotherapy cycle,self-efficacy level,and anxiety and depression level influenced CRF in patients with DLBCL during chemotherapy.

Association of overall survival benefit of radiotherapy with progression-free survival after chemotherapy for diffuse large B-cell lymphoma:A systematic review and meta-analysis

Objective:To evaluate whether improved progression-free survival(PFS)from radiotherapy(RT)translates into an overall survival(OS)benefit for diffuse large B-cell lymphoma(DLBCL).Methods:A systematic literature search identified randomized controlled trials(RCTs)and retrospective studies that compared combined-modality therapy(CMT)with chemotherapy(CT)alone.Weighted regression analyses were used to estimate the correlation between OS and PFS benefits.Cohen’s kappa statistic assessed the consis-tency between DLBCL risk-models and PFS patterns.Furthermore,the benefit trend of RT was analyzed by fitting a linear regression model to the pooled hazard ratio(HR)according to the PFS patterns.Results:For both 7 RCTs and 52 retrospective studies,correlations were found between PFS HR(HRPFS)and OS HR(HROS)at trial level(r=0.639-0.876),and between PFS and OS rates at treatment-arm level,regardless of CT regimens(r=0.882-0.964).Incorporating RT into CT increased about 18%of PFS,and revealed a different OS benefit profile.Patients were stratified into four CT-generated PFS patterns(>80%,>60-80%,>40-60%,and≤40%),which was consistent with risk-stratified subgroups(kappa>0.6).Absolute gain in OS from RT ranged from≤5%at PFS>80%to about 21%at PFS≤40%,with pooled HROS from 0.70(95%CI,0.51-0.97)to 0.48(95%CI,0.36-0.63)after rituximab-based CT.The OS benefit of RT was predominant in intermediate-and high-risk patients with PFS≤80%.Conclusion:We demonstrated a varied OS benefit profile of RT to inform treatment decisions and clinical trial design.

Cardiac involvement in disseminated diffuse large B-cell lymphoma,successful management with chemotherapy dose reduction guided by cardiac imaging: A case report and review of literature

BACKGROUND Secondary cardiac involvement by lymphoma has received limited attention in the medical literature, despite its grave prognosis. Although chemotherapy improves patients' survival, a subgroup of treated patients dies suddenly due to myocardial rupture following chemotherapy initiation. Reducing the initial chemotherapy dose with dose escalation to standard doses may be effective in minimizing this risk but the data are limited. We report on the successful management of a patient with disseminated diffuse large B-cell lymphoma(DLBCL) involving the heart using such approach.CASE SUMMARY An 18-year-old male presented to our hospital with six months history of progressive dyspnea, orthopnea and cough. On physical examination, the patient was found to have a plethoric and mildly edematous face, fixed elevation of the right internal jugular vein, suggestive of superior vena cava obstruction, and a pelvic mass. Investigations during admission including a thoracoabdominal computed tomography(CT) scan with CT guided biopsy of the pelvic mass,echocardiography and cardiac magnetic resonance imaging led to the diagnosis of disseminated DLBCL with cardiac involvement. The patients were successfully treated with chemotherapy dose reduction followed by dose escalation to standard doses, under the guidance of cardiac imaging. The patient completed chemotherapy and underwent a successful bone marrow transplant. He is currently in remission and has a normal left ventricular function.CONCLUSION Imaging-guided chemotherapy dosing may minimize the risk of myocardial rupture in cardiac lymphoma. Data are limited. Management should be individualized.

Clinical features, survival and prognostic factors of primary testicular diffuse large B-cell lymphoma

Objective： To assess the clinical features, survival and prognostic factors of primary testicular diffuse large B-cell lymphoma （DLBCL）. Methods： A retrospective study of 37 patients with primary testicular DLBCL was carried out from November 2003 to May 2012. Their clinical features, survival and prognostic factors were analyzed. Results： During a median follow-up period of 39.8 months （5.4-93.0 months）, the median progression-free survival （PFS） was 26.2 months （95% CI：0-65 months） and the 3-year overall survival （OS） rate was 78.4%. Within the whole cohort, the factors significantly associated with a superior PFS were limited stage （stage Ⅰ/Ⅱ）, lactate dehydrogenase （LDH） ≤245 U/L, international prognostic index （IPI） ≤1, primary tumor diameter 〈7.5 cm, and patients who had complete response （CR） and received doxoruhicin-contained chemotherapy （P〈0.05）. There was a trend toward superior outcome for patients who received combined therapy （surgery/ chemotherapy/radiotherapy） （P=0.055）. Patients who had CR, primary tumor diameter 〈7.5 cm and IPI score ≤1 were significantly associated with longer PFS at multivariate analysis. Conclusions： Primary testicular DLBCL had poorer survival. CR, primary tumor diameter and IPI were independent prognostic factors. The combined therapy of orchectomy, doxorubicin-contained chemotherapy and contralateral testicular radiotherapy （RT） seemed to improve survival.

Prognostic Significance of BCL2 Protein in Diffuse Large Cell Lymphoma of Head and Neck;Relation to Response to Chemotherapy

Diffuse large B cell lymphoma (DLBCL) is a heterogeneous disease that displays a highly variable clinical outcome. It is a neoplasm of large transformed B cells with a diffuse growth pattern. DLBCL is the most common type of non-Hodgkin’s lymphoma (NHL) (31% of all cases). Approximately half of patients with DLBCL are cured with current chemotherapy regimens. The purpose of this study was to evaluate BCl2 expression in 45 patients diagnosed with DLBCL of head and neck region and correlate the level of its immunohistochemical expression with different clinicopathological variables with emphasis upon patients’ age, gender, nodal or extra-nodal location of lymphoma, patients’ response to chemotherapy, progression-free survival (PFS) and overall survival (OS). A retrospective analysis of 45 patients diagnosed to have DLBCL. A cut off value of ≥ 50% protein expression denoted BCL2 positivity. Out of 45 cases, 36 cases (80%) revealed BCL2 positive expression and 9 cases (20%) were BCL2 negative. We found statistically significant differences in BCL2 expression regarding different patients’ responses to chemotherapy, patients’ OS and PFS (p ≤ 0.05). No statistically significant differences in BCL2 expression regarding the patients’ Ann Arbor clinical stage, age group and tumor site (nodal or extra-nodal, p > 0.05) using the Chi-square test. BCL2 expression was analyzed in relation to 5 years OS and PFS using Kaplan Meier curves and Log Rank test for survival analysis. Cases that demonstrated BCL2 positivity revealed shortened OS and PFS with highly statistically significant differences among the studied variables (p = 0.000). We also found that patients who respond well to the chemotherapeutic regimen had negative BCL2 expression, the differences were statistically significant (p = 0.015). In conclusion, BCL2 expression could be considered a predictor for patients’ chemotherapeutic response, OS and PFS.

Non-anthracycline chemotherapy associated with a poor outcome in elderly Egyptian patients with diffuse large B-cell non-Hodgkin lymphoma

Aim:Rituximab plus cyclophosphamide,doxorubicin,vincristine,and prednisone(CHOP)is the standard treatment for patients with diffuse large B-cell non-Hodgkin lymphoma(DLBCNHL).Nevertheless,anthracyclines are contraindicated for some patients,e.g.cardiac dysfunction,severe hepatic dysfunction,jaundice.Thus,this study assessed the effectiveness of non-anthracycline chemotherapy regimen cyclophosphamide,vincristine,and prednisone(CVP)in elderly DLBCNHL patients vs.the standard CHOP.Methods:This retrospective study included 418 DLBCNHL patients diagnosed between 2003 and 2006 and followed until March 2014.During this period of time,rituximab was not available for all patients,particularly for patients older than 60 years.Results:CHOP and CVP were administered to 351(84%)and 67(16%)patients,respectively.Older age and comorbidities,particularly cardiovascular and diabetes mellitus,were independent determinants for not receiving CHOP.Patients received more courses of CHOP treatment than that of CVP(6 vs.3 courses;P<0.001)and developed more toxicities(48.4%vs.23.9%;P<0.001),particularly fatigue,alopecia,and gastrointestinal tract toxicities.Complete response rate was higher in CHOP than in CVP(69.9%vs.29.9%;P<0.001).Moreover,early death was significantly higher in CVP group of patients than in CHOP(43.3%vs.8.6%;P<0.001).After a median follow-up of 71 months,the median overall survival(OS)and event-free survival(EFS)were signifi cantly better in CHOP than in CVP(49.5 vs.3.7 months and 32.2 vs.3.5 months;P<0.001 for both,respectively).Older age,poor age-adjusted International Prognostic Index scores,not receiving CHOP or consolidative radiotherapy were independent predictors of poor OS and EFS.Conclusion:Use of the CVP regime to treat DLBCNHL patients who were unfit to the standard CHOP treatment was associated with lower remission rates and poorer EFS and OS in this group of patients.

123例原发韦氏环弥漫大B细胞淋巴瘤临床特征与预后分析

目的探讨原发韦氏环弥漫大B细胞淋巴瘤（Waldeyer’s ring diffuse large B-cell lymphoma,WR-DLBCL）的临床特征、预后因素及治疗策略。方法回顾性分析天津医科大学肿瘤医院2006年1月至2014年6月收治的123例初治原发韦氏环DLBCL患者,对其临床特征、治疗方式及生存情况比较分析,Kaplan-Meier法计算3、5年生存率,Log rank检验单因素分析,Cox比例风险模型多因素分析。结果 123例患者中位年龄为56岁（16~80岁）,男72例。Ann Arbor分期：Ⅰ期20例,Ⅱ期63例,Ⅲ期23例,Ⅳ期17例。中位随访54月,3年和5年生存率分别为74.7%和56.3%,早期（Ⅰ/Ⅱ期）患者3年和5年生存率分别为84.2%和69.4%。单因素分析显示：年龄、体质状况、B症状、临床分期、国际预后指数（IPI）、乳酸脱氢酶（LDH）水平、近期疗效是影响预后的主要因素;多因素分析显示：IPI评分和近期疗效为独立预后因素。结论原发韦氏环DLBCL多为早期,肿瘤负荷较轻,生存率较高,多数可长期生存。IPI评分和近期疗效是独立预后因素。

韦氏环原发弥漫性大B细胞淋巴瘤分子分型的研究

目的探讨韦氏环原发弥漫性大B细胞淋巴瘤(DLBCL)的分子分型及与临床病理的关系。方法采用EnVision免疫组化法标记16例韦氏环原发弥漫性大B细胞淋巴瘤中MUM1、bcl-6、CD10、bcl-2、Ki-67的表达。结果 16例韦氏环原发弥漫性大B细胞淋巴瘤中,10例发生于扁桃体(62.5%)。5例为生发中心细胞样型(GCB),11例为非生发中心细胞样型(非GCB)。非GCB型的增殖活性与GCB型相似;GCB型和非GCB型中bcl-2表达的阳性率分别为20.0%(1/5)和54.5%(6/11)。结论韦氏环原发弥漫性大B细胞淋巴瘤以扁桃体好发,分子分型以非GCB型多见,预后较差。

LMR和LMR/LDH对原发韦氏环弥漫大B 细胞淋巴瘤预后的影响

目的探讨外周血LMR和LMR/LDH在原发韦氏环弥漫性大B细胞淋巴瘤(DLBCL)患者预后中的预测价值。方法收集71例原发韦氏环DLBCL患者临床资料,采用ROC曲线确定患者治疗前外周血LMR、LMR/LDH的最佳临界值,卡方检验分析LMR高低组和LMR/LDH高低组构成比和率。生存率的比较采用Kaplan-Meier法,单因素分析用Log rank法检验,多因素分析用Cox风险回归模型。结果 LMR和LMR/LDH临界值分别为2.97和1.56。高LMR组患者的预后明显优于低LMR组(P<0.001);高LMR/LDH组患者的预后明显优于低LMR/LDH组(P<0.001)。单因素分析显示年龄、B症状、临床分期、治疗疗效、IPI评分、LDH水平、LMR及LMR/LDH是影响早期韦氏环DLBCL患者预后的重要因素;多因素分析显示LMR/LDH、年龄、临床分期是其独立预后因素。结论 治疗前LMR和LMR/LDH在韦氏环DLBCL患者预后中可能具有一定的预测价值。

放疗在美罗华时代对局限期原发韦氏环弥漫大B细胞淋巴瘤的治疗价值

目的分析在美罗华联合化疗背景下,放疗对局限期韦氏环弥漫大B细胞淋巴瘤的治疗价值。方法收集2010年—2017年收治的93例Ⅰ-Ⅱ期原发韦氏环弥漫大B细胞淋巴瘤患者的临床资料,将仅接受美罗华联合CHOP或CHOP类似方案化疗的38例患者分为单纯化疗组,将接受化疗+巩固放疗的55例患者分为综合治疗组。采用Kaplan-Meier法计算无进展生存(PFS)、总生存(OS)、局部区域控制率(LRC),并行单因素分析;采用Logrank法检验两组患者生存差异,并行Cox多因素回归分析。结果本研究患者随访中位时间47个月,3年存活病例67例。单纯化疗组和综合治疗组患者的3年PFS分别为76.1%和94.2%(P=0.036),3年OS分别为78.6%和96.0%(P=0.032),3年LRC分别为83.1%和98.1%(P=0.015)。其中62例化疗后疗效评估为完全缓解(CR)的患者中,单纯化疗组和综合治疗组的3年PFS、OS和LRC分别为87.8%和97.6%(P=0.164)、93.8%和97.4%(P=0.522)、87.8%和100.0%(P=0.028)。进一步单因素分析结果显示,年龄>60岁和化疗疗效未达CR是PFS和OS的不良预后因素,B症状和化疗疗效未达CR是LRC的不良预后因素。多因素分析结果显示,年龄>60岁、B症状、化疗疗效未达CR是患者PFS的不良预后因素,年龄>60岁、化疗疗效未达CR是OS的不良预后因素,B症状、化疗疗效未达CR和未放疗是LRC的不良预后因素。结论Ⅰ-Ⅱ期原发韦氏环弥漫大B细胞淋巴瘤采用美罗华联合CHOP为主的化疗后的巩固性放疗可显著改善患者的PFS、OS和LRC,但仍需大样本和前瞻性研究进一步证实。

原发韦氏环弥漫性大B细胞与结外鼻型NK／T细胞淋巴瘤的临床特征和预后比较

目的比较原发韦氏环弥漫性大B细胞淋巴瘤（DLBCL）与结外鼻型NK／T细胞淋巴瘤（ENKTCL）的临床特征和预后差异。方法对2000--2008年间本院收治的122例DLBCL和44例ENKTCL进行回顾分析。DLBCL通常4—6周期CHOP方案化疗后加累及野放疗，早期NKTCL单纯扩大野放疗或加辅助化疗或放疗前加短周期（1—3周期）CHOP方案化疗。Kaplan—Meier法计算生存率并Logrank检验组间差异和单因素预后分析。结果随访率为82％，DLBCL和ENKTCL随访时间满5年者分别为32例和15例。DLBCL多见于扁桃体并伴有颈淋巴结累及，ENKTCL多见年轻男性、鼻咽Ⅰ期病变、B症状和侵犯周围结构。DLBCL和ENKTCL的5年总生存率、无进展生存率分别为74％、67％和68％、59％（X^2=0．53、1．06，P=0．468、0．303）；Ⅰ＋Ⅱ期的5年总生存率、无进展生存率分别为79％、76％和72％、62％（x^2=1．20、2．46，P=0．273、0．117）。单因素分析显示年龄〉60岁、乳酸脱氢酶升高、东部肿瘤协作组评分〉1、国际预后指数评分≥1、Ⅲ＋Ⅳ期病变和大肿块与DLBCL的预后相关（X^2=9．40、12．72、6．15、10．36、12．48、5．53，P=0．002、0．000、0．013、0．001、0．000、0．019），而国际预后指数评分≥1和年龄〉60岁与ENKTCL的预后相关（x^2=3．98、8．41，P=0．046、0．004）。结论原发韦氏环的DLBCL与ENKTCL临床特征不同，但不同治疗原则下两者预后相似。

200例原发韦氏环弥漫大 B 细胞淋巴瘤的治疗及预后

目的：分析原发韦氏环弥漫大 B 细胞淋巴瘤的疗效和预后因素。方法2000—2013年收治200例确诊为原发韦氏环弥漫大 B 细胞淋巴瘤，Ⅰ期50例，Ⅱ期125例，Ⅲ＋Ⅳ期25例。大部分患者接受4～6周期 CHOP 或 CHOP 为主方案化疗以及受累野放疗（韦氏环＋颈部淋巴结区域）。 Kaplan.Meier 法计算 OS、PFS、LRC，Logrank 法检验和单因素分析，Cox 多因素分析。结果5年样本数量71例，全组5年OS、PFS 和 LRC 分别为78％、72％和87％。放化疗组的 OS、PFS、LRC 均高于单纯化疗组，分别为86％∶70％、84％∶58％和97％∶66％（P＝0.001、0.000、0.000）。单因素分析显示年龄、肿瘤大小、分期、LDH 和 IPI 是 OS、PFS 和 LRC 共同预后因素（P＝0．000～0.036），PFS 预后因素还包括 ECOG 评分（P＝0.018）。多因素分析显示年龄和分期是 OS 和 LRC 的预后因素（P＝0．003～0.022），PFS 的预后因素是年龄（P＝000）。结论韦氏环弥漫大 B 细胞淋巴瘤具有独特的临床特征和疗效好的特点。早期患者加入放疗可以显著提高 OS、PFS 和 LRC。

口腔颌面部弥漫大B细胞淋巴瘤的临床特征及预后分析

目的:分析口腔颌面部弥漫大B细胞淋巴瘤(OC-MR DLBCL)患者临床特征,探讨其预后及可能影响因素。方法:回顾性收集2015年1月—2022年3月收治的60例OC-MR DLBCL患者临床资料,并与67例非OC-MR DLBCL患者进行比较。Kaplan-Meier法计算生存率,log-rank检验和Cox回归模型进行单因素及多因素生存预后分析。结果:60例OC-MR DLBCL患者中,男41例,女19例,中位年龄64岁;non-GCB型占71.4%,Ann ArborⅠ/Ⅱ期占58.3%,60.0%患者属于IPI评分(0~2分)低危组。OC-MR DLBCL与非OC-MR DLBCL患者比较,性别、年龄及Hans分类分布差异无统计学意义,但Ⅲ/Ⅳ期及IPI高危患者占比均较低(P<0.05)。OC-MR DLBCL患者ORR为91.7%,其中CR率60.0%,1年OS率为91.3%,2年OS率为63.6%;非OC-MR患者ORR为88.0%,CR率53.0%,1年OS率为89.6%,2年OS率为75.6%。OC-MR与非OC-MR组DLBCL患者间OS及PFS比较,差异无统计学意义(P>0.05)。生存分析显示IPI评分高危及起病于非韦氏环的OC-MR DLBCL患者预后不良,IPI是影响OS及PFS的独立预后因素(P<0.05)。非OC-MR组患者生存较韦氏环起病患者差,优于非韦氏环者,但均差异无统计学意义(P>0.05)。结论:OC-MR DLBCL患者有特异性临床特征,多数处于早期及低危状态,整体预后不优于非OC-MR DLBCL。IPI及不同起病部位是影响OC-MR DLBCL预后的重要因素。

Ⅰ/Ⅱ期韦氏环弥漫大B细胞淋巴瘤免疫化疗后放疗疗效观察

目的评价免疫化疗后早期韦氏环弥漫大B细胞淋巴瘤(DLBCL)的预后因素及放疗价值。方法回顾性分析2009-03-21-2017-05-16本院收治的60例Ⅰ/Ⅱ期韦氏环DLBCL患者临床资料。将患者分为放疗组(33例)和未放疗组(27例),均接受利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松(R-CHOP)方案的免疫化疗,放疗组在免疫化疗后接受累及野放疗(中位剂量:46 Gy)。生存分析采用Kaplan-Meier曲线描述并行log-rank检验,Cox比例风险模型分析影响预后的因素。结果全组随访达5年者有46例,5年总生存(OS)率、无进展生存(PFS)率和局部区域控制(LRC)率分别为80.00%、67.95%和84.47%。单因素分析结果显示,Ann Arbor分期为Ⅱ期、美国东部肿瘤协作组(ECOG)评分≥2分、分期改良国际预后指数(smIPI)评分≥2分和未放疗是OS的预后不良因素,Ann Arbor分期为Ⅱ期、ECOG评分≥2分是PFS的预后不良因素,而放疗则是LRC的有利因素。多因素分析结果显示,与OS有关联的因素包括年龄(HR=3.660,95%CI:1.026~13.053)、Ann Arbor分期(HR=10.249,95%CI:1.633~64.322)和放疗(HR=0.386,95%CI:0.160~0.933);与PFS有关联的因素为Ann Arbor分期(HR=7.343,95%CI:1.702~31.683);与LRC有关联的因素为放疗(HR=0.143,95%CI:0.031~0.667)。免疫治疗后获得部分缓解的患者接受放疗可改善5年LRC率(100.00%vs 57.14%),χ^(2)=5.691,P=0.017。结论早期韦氏环DLBCL免疫化疗后预后良好,放疗可改善免疫化疗后达到部分缓解者的局部控制。

IMRT早期韦氏环DLBCL的长期观察

目的 研究IMRT对原发于韦氏环早期DLBCL的疗效、预后、放射剂量及不良反应。 方法 收集2008—2015年Ⅰ、Ⅱ期韦氏环DLBCL病例 80例,放化疗为主,3例单纯放疗。化疗后CR 24例,PR 53例。原发灶及颈部淋巴结引流区IMRT。采用Kaplan-Meier法计算生存率,Cox模型预后因素分析,不良反应分级使用RTOG标准。 结果 中位随访时间为64个月,5年LRC、OS、PFS率分别为94%、88%、84%。DVH显示PGTV最高、平均和最低剂量分别为54.47、52.27、38.83 Gy。因素分析显示年龄〉60岁、LDH升高为OS影响因素（P=0.009、0.002）,年龄〉60岁、IPI≥2分及LDH升高为PFS影响因素（P=0.001、0.035、0.007）。全组急性口腔黏膜反应1级 12例、2级 53例、3级 8例,晚期不良反应口干1级 16例、2级 13例。 结论 应用IMRT技术治疗原发韦氏环的早期DLBCL,获得了较理想的LRC、PFS、OS率,同时不良反应可耐受。

利妥昔单抗时代放疗对早期韦氏环弥漫大B细胞淋巴瘤的作用价值

目的：分析早期韦氏环弥漫大B细胞淋巴瘤接受利妥昔单抗加CHOP为主方案化疗后放疗的作用价值。方法2000—2013年收治83例确诊为原发韦氏环弥漫大B细胞淋巴瘤患者，其中Ⅰ期25例、Ⅱ期58例。全组接受了利妥昔单抗加CHOP为主方案化疗，62例接受了受累野放疗（韦氏环＋颈部淋巴结区域），21例未接受放疗。 Kaplan-Meier法计算OS、PFS、LRC并Logrank法检验和单因素分析，Cox模型多因素分析。结果全组5年样本数18例，5年OS、PFS和LRC率分别为89％、84％和90％。单因素分析显示年龄＞60岁、LDH升高、ECOG≥2分和IPI≥2分是OS的预后不良因素。年龄＞60岁、肿瘤≥5 cm、ECOG≥2分和IPI≥2分是PFS和LRC的影响因素。在利妥昔单抗治疗基础上加入巩固性放疗比未放疗者提高了5年PFS、LRC，分别为94％比58％（ P＝0.003）、100％比61％（ P＝0.000），OS有增加趋势（94％比71％，P＝0.063）。结论早期韦氏环弥漫大B细胞淋巴瘤利妥昔单抗加CHOP为主方化疗后巩固性放疗显著改善了PFS、LRC率，并可能改善OS率，需大样本和前瞻性研究证实。

早期韦氏环弥漫大B细胞淋巴瘤预后分析

目的分析早期韦氏环弥漫大B细胞淋巴瘤(WR-DLBCL)接受CHOP为主治疗的疗效及预后因素.方法2006-2018年间收治137例确诊为WR-DLBCL患者,其中Ⅰ期22例,Ⅱ期115例.全组接受了CHOP类为主方案化疗,其中62例使用了利妥昔单抗,87例接受了累及野放疗.Kaplan-meier法计算总生存(OS)、无进展生存(PFS)、无局部区域复发生存(LRRFS),并Logrank法检验和单因素分析,Cox模型多因素分析.结果全组5年OS、PFS、LRRFS分别为78.6%、69.5%、83.2%,综合治疗组分别为87.5%、80.2%、90.9%,单纯化疗组分别为64.2%、53.6%、72.9%.单因素分析显示乳酸脱氢酶、国际预后指数评分、大肿块、利妥昔单抗、化疗周期及综合治疗是影响OS、PFS因素;乳酸脱氢酶、大肿块、综合治疗是影响LRRFS因素.多因素分析显示乳酸脱氢酶、综合治疗模式、利妥昔单抗是影响OS因素,LDH、综合治疗模式是影响PFS因素,LDH是影响LRRFS因素.结论早期WR-BLBCL预后良好,在利妥昔单抗治疗的时代,化疗联合放疗的综合治疗方式仍然是早期WR-BLBCL的有效手段.