老年弥漫大B细胞淋巴瘤50例患者的临床特征和预后分析

Clinical characteristics and prognosis of diffuse large B-cell lymphoma: report of 50 elderly patients

摘要:

目的 探讨老年弥漫大B细胞淋巴瘤（DLBCL）患者的临床特征及预后因素。方法 回顾性分析2010年1月至2013年1月，第四军医大学西京医院血液内科收治的50例年龄≥70岁的老年DLBCL患者，收集整理年龄、Ann-Arbor分期、B症状、国际预后指数（IPI）、乳酸脱氢酶（LDH）、β2?微球蛋白、Ki-67等资料进而分析临床特点；采用Kaplan-Meier法进行生存分析，并进行单因素分析评估预后。结果 50例初发老年DLBCL患者中，60%患者为Ⅲ～Ⅳ期，54% IPI评分为3～5分，52%有B症状，75%原发部位为结外。在老年患者中，调整剂量的化疗疗效优于放疗及对症支持治疗。利妥昔单抗联合剂量调整化疗（R-CHOP）组完全缓解（CR）率优于不包括利妥昔单抗的剂量调查化疗（CHOP/COP）组。患者中位生存时间为 8个月，1、2、3年总生存率分别为48.5%、30.8%、11.5%。生存分析发现Ki-67对患者生存有显著的影响，尤其是Ki-67＞80%患者预后差。结论 老年患者以疾病分期晚，易合并其他系统疾病，生存期短为特征，具有更高的DLBCL发病率，Ki-67是一个重要的不良预后指标。R-CHOP方案可明显提高CR率，并且足够疗程的化疗将显著改善超高龄患者的生存期。

Abstract:

Objective To investigate the clinical characteristics and prognostic factors of diffuse large B-cell lymphoma (DLBCL) in the elderly. Methods A total of 50 DLBCL patients (≥70 years old) admitted in our department from Jan. 2010 to Jan. 2013 were enrolled in this study. Clinical data including age, Ann-Arbor stage, B symptoms, international prognostic index (IPI), serum levels of lactic dehydrogenase (LDH), β2-microglobulin (β2-MG) and Ki-67, and other indices were collected and retrospectively analyzed. Survival analysis was performed by Kaplan-Meier survival analysis (the Log-rank test), and the correlation of these indices with prognosis was performed by univariate analysis. Results Among the 50 elderly with initial DLBCL, 60% were at Ann-Arbor stage of Ⅲ?Ⅳ, 54% got IPI score of 3?5 points, 52% had B symptoms, and 75% were with extranodal as primary site of the disease. In the cohort, the therapeutic effect was better in the patients given dose-adjusted chemotherapy than those receiving radiotherapy and supportive therapy. Moreover, the complete remission (CR) rate was higher in the patients getting R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine and prednison) than those of CHOP/COP regimens. The median survival time was 8 months, and the 1-, 2-, 3-year overall survival rate (OS) was 48.5%, 30.8% and 11.5%, respectively. Survival analysis showed Ki-67 had great effect on prognosis, and those with Ki-67 ＞80% had poor outcome. Conclusion Elderly patients are characterized by being at late stage of disease, with various combined diseases, and having short survival time, and have a high incidence of DLBCL. Ki-67 is regarded as an important factor for poor prognosis. The R-CHOP scheme greatly improves CR rate, and adequate chemotherapy is important to prolong survival time in the elderly DLBCL patients.