摘要
目的比较IPI、美国国家综合癌症网络IPI（NCCN-IPI）及年龄调整的IPI（aa-IPI）三种预后分层模型在弥漫大B细胞淋巴瘤（DLBCL）患者中的预后分层能力。方法回顾性分析2003年1月至2012年12月311例初治DLBCL患者资料，根据治疗方案将患者分为CHOP（环磷酰胺、多柔比星、长春新碱、泼尼松）方案及利妥昔单抗（R）-CHOP方案组，分别采用IPI、NCCN-IPI及aa-IPI对DLBCL患者进行危险度分层。采用Harrell＇s C统计评价不同模型的预后分层能力。结果①311例患者中接受CHOP方案治疗者128例，接受R-CHOP方案治疗者183例。②CHOP方案组患者的5年总生存（OS）率结果显示，aa—IPI（71．0％对25．0％，P〈0，001）、NCCN—IPI（59．7％对26．8％，P〈0．001）和IPI（47．6％对36．6％，P=0．003）均能区分中低危和中高危组患者，但前两者区分效果似乎更佳；而R—CHOP方案组，NCCN-IPI拥有更好的预后分层能力，其低危、中低危、中高危患者的5年OS率分别为96．0％、83．0％、66．5％（P：0．009）。③Harrell＇s C分析结果显示，IPI、NCCN-IPI及aa．IPI预测接受CHOP方案者OS的一致性指数（c—index）分别为0．546、0．667、0．698；预测接受R．CHOP方案者OS的C—index分别为0．611、0．654、0．695。④在≤60岁患者中，IPI、NCCN—IPI、aa—IPI预测接受CHOP方案者OS的C-index分别为0．534、0．675、0．698；预测接受R—CHOP方案者OS的C—index分别为0．584、0．648、0．695。结论NCCN—IPI对于接受利妥昔单抗联合化疗的DLBCL患者有较好的预后分层能力，而aa-IPI对于较年轻的DLBCL患者预后分层能力可能更佳。
Objective To explore the prognostic value of the international prognostic index （IPI）, the national comprehensive cancer network IPI（NCCN-IPI）and the age-adjusted IPI （aa-IPI） in diffuse large B cell lymphoma. Methods A total of 311 patients with de novo diffuse large B-cell lymphoma （DLBCL） diagnosed from 2003 to 2012 in Nanfang hospital were included. All patients were divided into CHOP （cyclophosphamide, vincristine, doxorubicin, and prednisone） and R-CHOP （rituximab, CHOP） groups. Survival analysis was compared among IPI, NCCN-IPI and aa-IPI models. Discrimination of three different prognostic models was assessed using the Harrell＇ s C statistic. Results A total of 311 patients were analyzed. Among them, 128 patients were treated with CHOP regimen and other 183 patients were treated with R-CHOP regimen. In CHOP groups, both NCCN-IPI （5-year OS： 59.7% vs 26.8%, P 〈 0.001） and aa- IPI （5-year OS： 71.0% vs 25.0%, P 〈 0.001） showed better risk stratification for low-intermediate and high- intermediate group than the IPI （5-year OS： 47.6% vs 36.6%, P = 0.003）. However, in the patients treated with R-CHOP, NCCN-IPI showed better risk stratification in low, low-intermediate, high-intermediate groups （5-year OS： 96.0% vs 83.0% vs 66.5%, P = 0.009）. According to the Harrell＇ s C statistic, C-index of IPI, NCCN-IPI and aa-IPI for overall survival （OS） were 0.546, 0.667, 0.698 in CHOP group and 0.611,0.654, 0.695 in R-CHOP group respectively. In patients younger than 60 years old, C-index of IPI, NCCN- IPI and aa-IPI for OS were 0.534, 0.675, 0.698 in CHOP group and 0.584, 0.648, 0.695 in R-CHOP respectively. Conclusion The NCCN-IPI is more powerful than IPI and aa-IPI in DLBCL patients receiving R-CHOP. aa-IPI is a preferable model in predicting prognosis than IPI and NCCN-IPI in anthracycline-based chemotherapy without rituximab.
作者
宋佳琳
魏小磊
张元坤
郝晓晓
黄伟民
韦祁
魏永强
冯茹
Song Jialin;Wei Xiaolei;Zhang Yuankun;Hao Xiaoxiao;Huang Weimin;Wei Qi;Wei Yongqiang;Feng Ru(Department of Hematology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2018年第9期739-744,共6页
Chinese Journal of Hematology
基金
国家自然科学基金（81600165、81670183）
关键词
淋巴瘤
大B细胞
弥漫性
预后指数
预后
Lymphoma
large B-cell
diffuse
Prognostic index
Prognosis
