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
|
摘要
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 elevated β2-MG level(P <0.05) also influenced OS. COX multivariate analysis showed that the elevated β2-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.
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 elevated β2-MG level(P <0.05) also influenced OS. COX multivariate analysis showed that the elevated β2-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.
引文
1 Wight JC,Chong G,Grigg AP,et al.Prognostication of diffuse large B-cell lymphoma in the molecular era:moving beyond the IPI.Blood Rev,2018;32(5):400-415.
2张之南,郝玉书,赵永强,等.主编.血液病学.2版.北京:人民卫生出版社,2011:1005-1008.
3 International Non-Hodgkin's Lymphoma Prognostic Factors Project.A predictive model for aggressive non-Hodgkin's lymphoma.N Engl J Med,1993;329(14):987-994.
4 Yoon JH,Kim JW,Jeon YW,et al.Role of frontline autologous stem cell transplantation in young,high-risk diffuse large B-cell lymphoma patients.Korean J Intern Med,2015;30(3):362-371.
5 Kanemasa Y,Shimoyama T,Sasaki Y,et al.Beta-2 microglobulin as a significant prognostic factor and a new risk model for patients with diffuse large B-cell lymphoma.Hematol Oncol,2017;35(4):440-446.
6 Miyashita K,Tomita N,Taguri M,et al.Beta-2 microglobulin is a strong prognostic factor in patients with DLBCL receiving R-CHOPtherapy.Leuk Res,2015;39(11):1187-1191.
7 Sehn LH,Scott DW,Chhanabhai M,et al.Impact of concordant and discordant bone marrow involvement on outcome in diffuse large B-cell lymphoma treated with R-CHOP.J Clin Oncol,2011;29(11):1452-1457.
8 El-Galaly TC,Villa D,Alzahrani M,et al.Outcome prediction by extranodal involvement,IPI,R-IPI,and NCCN-IPI in the PET/CTand rituximab era:A Danish-Canadian study of 443 patients with diffuse-large B-cell lymphoma.Am J Hematol,2015;90(11):1041-1046.
9 Sehn LH,Berry B,Chhanabhai M,et al.The revised International Prognostic Index(R-IPI)is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP.Blood,2007;109(5):1857-1861.
10 Biccler J,Eloranta S,de Nully Brown P,et al.Simplicity at the cost of predictive accuracy in diffuse large B-cell lymphoma:a critical assessment of the R-IPI,IPI,and NCCN-IPI.Cancer Med,2018;7(1):114-122.
11 Zhou Z,Sehn LH,Rademaker AW,et al.An enhanced International Prognostic Index(NCCN-IPI)for patients with diffuse large B-cell lymphoma treated in the rituximab era.Blood,2014;123(6):837-842.
12 Ichiki A,Carreras J,Miyaoka M,et al.Clinicopathological analysis of 320 cases of diffuse large B-cell lymphoma using the Hans classifier.J Clin Exp Hematop,2017;57(2):54-63.
13 Bajwa AA,Khadim MT,Din HU,et al.Immunohistochemical expression of CD10,BCL6 and MUM1 in differentiating diffuse large B cell lymphoma subtypes.J Coll Physicians Surg Pak,2017;27(10):621-624.
14 Horn H,Ziepert M,Wartenberg M,et al.Different biological risk factors in young poor-prognosis and elderly patients with diffuse large B-cell lymphoma.Leukemia,2015;29(7):1564-1570..
15 Bolte?ar L,Prevodnik VK,Perme MP,et al.Comparison of the algorithms classifying the ABC and GCB subtypes in diffuse large B-cell lymphoma.Oncol Lett,2018;15(5):6903-6912.
16 Czuczman MS,TrněnyM,Davies A,et al.A Phase 2/3 multicenter,randomized,open-label study to compare the efficacy and safety of lenalidomide versus investigator's choice in patients with relapsed or refractory diffuse large B-cell lymphoma.Clin Cancer Res,2017;23(15):4127-4137.
17 Wiernik PH,Lossos IS,Tuscano JM,et al.Lenalidomide monotherapy in relapsed or refractory aggressive non-Hodgkin's lymphoma.JClin Oncol,2008;26(30):4952-4957.
18 Nakaya A,Fujita S,Satake A,et al.Upfront high dose chemotherapy combined with autologous stem cell transplantation:potential survival benefit for patients with high risk diffuse large B cell lymphoma.Oncol Lett,2017;14(3):3803-3808.
19 Thakral B,Medeiros LJ,Desai P,et al.Prognostc impact of CD5expression in diffuse large B-cell lymphoma in patents treated with rituximab-EPOCH.Eur J Haematol,2017;98(4):415-421.
20 Roncati L.De novo CD5-positive primary gastric diffuse large B-cell lymphoma coexpressing MYC and BCL6:towards a proper subset of double-hit,triple-hit and,maybe,quadruple-hit B-cell lymphomas?Chonnam Med J,2018;54(1):80-82.
21 P?tra?cu AM,Rotaru I,Olar L,et al.The prognostic role of Bcl-2,Ki67,c-MYC and p53 in diffuse large B-cell lymphoma.Rom JMorphol Embryol,2017;58(3):837-843.
22 Kü?ükzeybek BB,Bener S,?all?AO,et al.Prognostic significance of Bcl-2 and p53 protein expressions and Ki67 Proliferative Index in diffuse large B-cell lymphoma.Turk J Haematol,2013;30(3):275-282.
2张之南,郝玉书,赵永强,等.主编.血液病学.2版.北京:人民卫生出版社,2011:1005-1008.
3 International Non-Hodgkin's Lymphoma Prognostic Factors Project.A predictive model for aggressive non-Hodgkin's lymphoma.N Engl J Med,1993;329(14):987-994.
4 Yoon JH,Kim JW,Jeon YW,et al.Role of frontline autologous stem cell transplantation in young,high-risk diffuse large B-cell lymphoma patients.Korean J Intern Med,2015;30(3):362-371.
5 Kanemasa Y,Shimoyama T,Sasaki Y,et al.Beta-2 microglobulin as a significant prognostic factor and a new risk model for patients with diffuse large B-cell lymphoma.Hematol Oncol,2017;35(4):440-446.
6 Miyashita K,Tomita N,Taguri M,et al.Beta-2 microglobulin is a strong prognostic factor in patients with DLBCL receiving R-CHOPtherapy.Leuk Res,2015;39(11):1187-1191.
7 Sehn LH,Scott DW,Chhanabhai M,et al.Impact of concordant and discordant bone marrow involvement on outcome in diffuse large B-cell lymphoma treated with R-CHOP.J Clin Oncol,2011;29(11):1452-1457.
8 El-Galaly TC,Villa D,Alzahrani M,et al.Outcome prediction by extranodal involvement,IPI,R-IPI,and NCCN-IPI in the PET/CTand rituximab era:A Danish-Canadian study of 443 patients with diffuse-large B-cell lymphoma.Am J Hematol,2015;90(11):1041-1046.
9 Sehn LH,Berry B,Chhanabhai M,et al.The revised International Prognostic Index(R-IPI)is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP.Blood,2007;109(5):1857-1861.
10 Biccler J,Eloranta S,de Nully Brown P,et al.Simplicity at the cost of predictive accuracy in diffuse large B-cell lymphoma:a critical assessment of the R-IPI,IPI,and NCCN-IPI.Cancer Med,2018;7(1):114-122.
11 Zhou Z,Sehn LH,Rademaker AW,et al.An enhanced International Prognostic Index(NCCN-IPI)for patients with diffuse large B-cell lymphoma treated in the rituximab era.Blood,2014;123(6):837-842.
12 Ichiki A,Carreras J,Miyaoka M,et al.Clinicopathological analysis of 320 cases of diffuse large B-cell lymphoma using the Hans classifier.J Clin Exp Hematop,2017;57(2):54-63.
13 Bajwa AA,Khadim MT,Din HU,et al.Immunohistochemical expression of CD10,BCL6 and MUM1 in differentiating diffuse large B cell lymphoma subtypes.J Coll Physicians Surg Pak,2017;27(10):621-624.
14 Horn H,Ziepert M,Wartenberg M,et al.Different biological risk factors in young poor-prognosis and elderly patients with diffuse large B-cell lymphoma.Leukemia,2015;29(7):1564-1570..
15 Bolte?ar L,Prevodnik VK,Perme MP,et al.Comparison of the algorithms classifying the ABC and GCB subtypes in diffuse large B-cell lymphoma.Oncol Lett,2018;15(5):6903-6912.
16 Czuczman MS,TrněnyM,Davies A,et al.A Phase 2/3 multicenter,randomized,open-label study to compare the efficacy and safety of lenalidomide versus investigator's choice in patients with relapsed or refractory diffuse large B-cell lymphoma.Clin Cancer Res,2017;23(15):4127-4137.
17 Wiernik PH,Lossos IS,Tuscano JM,et al.Lenalidomide monotherapy in relapsed or refractory aggressive non-Hodgkin's lymphoma.JClin Oncol,2008;26(30):4952-4957.
18 Nakaya A,Fujita S,Satake A,et al.Upfront high dose chemotherapy combined with autologous stem cell transplantation:potential survival benefit for patients with high risk diffuse large B cell lymphoma.Oncol Lett,2017;14(3):3803-3808.
19 Thakral B,Medeiros LJ,Desai P,et al.Prognostc impact of CD5expression in diffuse large B-cell lymphoma in patents treated with rituximab-EPOCH.Eur J Haematol,2017;98(4):415-421.
20 Roncati L.De novo CD5-positive primary gastric diffuse large B-cell lymphoma coexpressing MYC and BCL6:towards a proper subset of double-hit,triple-hit and,maybe,quadruple-hit B-cell lymphomas?Chonnam Med J,2018;54(1):80-82.
21 P?tra?cu AM,Rotaru I,Olar L,et al.The prognostic role of Bcl-2,Ki67,c-MYC and p53 in diffuse large B-cell lymphoma.Rom JMorphol Embryol,2017;58(3):837-843.
22 Kü?ükzeybek BB,Bener S,?all?AO,et al.Prognostic significance of Bcl-2 and p53 protein expressions and Ki67 Proliferative Index in diffuse large B-cell lymphoma.Turk J Haematol,2013;30(3):275-282.