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    175例弥漫大B细胞淋巴瘤的临床特征及预后分析

    Clinical Characteristics and Prognostic Analysis of 175 Cases of Diffuse Large B-Cell Lymphoma

      摘要
    • 摘要:
      目的 探讨弥漫大B细胞淋巴瘤（diffuse large B-cell lymphoma，DLBCL）患者临床特点、预后影响因素以及生存情况。
      方法 收集徐州医科大学附属医院血液科2020年1月—2023年12月初诊初治的175例DLBCL患者的临床资料，探究其临床特点、患者预后的影响因素以及生存分析。
      结果 175例患者中男性92例（52.6%）。中位年龄59（范围：19~89）岁，其中年龄>60岁的患者有83例（47.4%）。有B症状的患者42例（24.0%）。根据Hans分型，生发中心来源62例（35.4%），美国东部肿瘤协作组（Eastern Cooperative Oncology Group，ECOG）≥2分患者50例（28.6%），依据Ann Arbor分期为Ⅲ~Ⅳ期共113例（64.6%），国际预后指数（international prognostic index，IPI）评分3~5分患者共64例（36.6%），乳酸脱氢酶（lactate dehydrogenase，LDH）升高患者63例（36.0%），β2-微球蛋白（β2-microglobulin，β2-MG）升高患者42例（24.0%），Ki-67>80%患者53例（30.3%）。中位随访时间为32.6（16.9~43.6）个月，2年总生存（overall survival，OS）率为85.3%，2年无进展生存（progression-free survival，PFS）率为82.7%。生存分析显示：年龄>60岁、B症状、ECOG评分≥2分、Ann Arbor Ⅲ~Ⅳ期、IPI评分>2分、LDH升高、β2-MG升高、Ki-67>80%以及结外侵犯个数≥2个具有更差的PFS；年龄>60岁、ECOG评分≥2分、Ann Arbor分期Ⅲ~Ⅳ、IPI评分>2分、LDH升高、β2-MG升高、Ki-67>80%以及结外侵犯个数≥2个具有更差的OS（P值均<0.05）。多因素分析结果显示：LDH升高、β2-MG升高以及Ki-67>80%是影响患者PFS和OS的独立危险因素（P<0.05）。
      结论 DLBCL患者LDH升高、β2-MG升高、Ki-67>80%是影响患者PFS和OS的独立危险因素，提示高肿瘤负荷和高肿瘤增殖活性指数的DLBCL患者预后不佳。

       

      Abstract:
      Objective To investigate the clinical characteristics, prognostic factors, and survival outcomes of patients with diffuse large B-cell lymphoma (DLBCL).
      Methods Clinical data of 175 newly diagnosed and untreated DLBCL patients from the Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, between January 2020 and December 2023 were collected to analyze their clinical features, factors influencing prognosis, and survival.
      Results Among the 175 patients, 92 (52.6%) were male. The median age was 59 years (range: 19–89), with 83 patients (47.4%) aged >60 years. B symptoms were present in 42 patients (24.0%). According to the Hans classification, 62 cases (35.4%) were of germinal center B-cell (GCB) subtype. There were 50 patients (28.6%) with an Eastern Cooperative Oncology Group (ECOG) score ≥2, 113 patients (64.6%) with Ann Arbor stage Ⅲ-Ⅳ, and 64 patients (36.6%) with an international prognostic index (IPI) score of 3–5. Elevated lactate dehydrogenase (LDH) was observed in 63 patients (36.0%), elevated β2-microglobulin (β2-MG) in 42 patients (24.0%), and Ki-67 >80% in 53 patients (30.3%). The median follow-up time was 32.6 (16.9–43.6) months, with a 2-year overall survival (OS) rate of 85.3% and a 2-year progression-free survival (PFS) rate of 82.7%. Survival analysis showed that age >60 years, B symptoms, ECOG score ≥2, Ann Arbor stage Ⅲ-Ⅳ, IPI score >2, elevated LDH, elevated β2-MG, Ki-67 >80%, and number of extranodal involvement ≥2 were associated with worse PFS; age >60 years, ECOG score ≥2, Ann Arbor stage Ⅲ-Ⅳ, IPI score >2, elevated LDH, elevated β2-MG, Ki-67 >80%, and number of extranodal involvement ≥2 were associated with worse OS (all P<0.05). Multivariate analysis indicated that elevated LDH, elevated β2-MG, and Ki-67 >80% were independent risk factors for both PFS and OS (P < 0.05).
      Conclusion Elevated LDH, elevated β2-MG and Ki-67 >80% are independent risk factors for PFS and OS in DLBCL patients, suggesting that high tumor burden and high tumor proliferation index indicate poor prognosis in DLBCL patients.

       

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