摘要
目的:分析低级别滤泡淋巴瘤(follicular lymphoma,FL)在各年龄段人群中的临床特征及预后。方法:收集2011年1月至2019年12月郑州大学第一附属医院初治的82例低级别FL患者的病例资料,男女比为1∶1.05,中位年龄52(19~84)岁。分类变量行Chi-square检验,采用Kaplan-Meier法、Logistic单因素分析及Cox回归模型多因素分析进行生存资料分析。结果:82例患者分为年龄<40岁、40~59岁和≥60岁3个组。随着年龄段的上升,患者多见红细胞沉降率(erythrocyte sedimentation rate,ESR)增快、外周血血小板与淋巴细胞比值(platelet to lymphocyte ratio,PLR)升高、Bcl-2表达呈阳性的患者比例升高、ECOG评分和FLIPI-2评分升高,且初治效果达到完全缓解(complete response,CR)的比例降低(P<0.05)。随访的73例患者2、5年总生存率(overall survival,OS)分别为97.2%和74.1%,无进展生存率(progression-free survival,PFS)分别为91.5%和88.8%。73例患者在年龄<40岁、40~59岁和≥60岁3个组中,5年OS分别为100%、73.8%和46.5%(P=0.014)。比较各组PFS差异无统计学意义(P=0.190)。根据化疗方案分析,利妥昔单抗联合化疗与单用化疗组,5年OS分别为85.7%和69.3%(P=0.004),5年PFS分别为96.8%和56.3%(P<0.001)。单用化疗组中3个年龄组3年OS分别为100%、75.0%和71.4%(P=0.048),利妥昔单抗联合化疗组中各年龄组的3年OS无显著性差异(P=0.050)。根据Ann Arbor分期分析,晚期组(Ⅲ+Ⅳ期)中3个年龄组的5年OS分别为100%、88.9%和47.7%(P=0.046),早期组(Ⅰ+Ⅱ期)各年龄组的5年OS无显著性差异(P=0.414)。结论:低级别FL患者预后随年龄段的上升变差,男性为预后不良因素,利妥昔单抗联合化疗可以改善预后,延长患者生存期。
Objective:To analyze and compare the clinical characteristics and prognosis of low-grade follicular lymphoma(FL)in different age groups.Methods:We obtained the data of clinical and pathological indicators from 82 patients with low-grade FL who were newly treated at The First Affiliated Hospital of Zhengzhou University from January 2011 to December 2019.The male to female ratio was 1:1.05,with a median age of 52(19-84)years.Categorical variables were analyzed using the Chi-square test.The Kaplan-Meier method was used for survival analysis,and differences in survival were assessed using the Log-rank test.Logistic univariate analysis and Cox multivariate regression model analysis were performed to analyze the factors affecting survival.Results:The 2-year and 5-year overall survival(OS)and progression-free survival(PFS)rates in the 73 patients who completed follow-up were 97.2%and 74.1%and 91.5%and 88.8%,respectively.Eighty-two patients were assigned into three age groups:<40 years,40-59 years,and≥60 years.With increasing age,patients showed a higher erythrocyte sedimentation rate(ESR),platelet to lymphocyte ratio(PLR),Eastern Cooperative Oncology Group(ECOG)score,follicular lymphoma international prognostic index-2(FLPI-2)score,and Bcl-2 positive ratio.Moreover,the complete response rate reduced after initial treatment(P<0.05).The 5-year OS rates in the<40 years,40-59 years,and≥60 years age groups were 100%,73.8%,and 46.5%,respectively(P=0.014).There was no significant difference in PFS between the groups(P=0.190).Concerning the chemotherapy regimen,the 5-year OS rates in the rituximab plus chemotherapy and chemotherapy only groups were 85.7%and 69.3%,respectively(P=0.004);the corresponding 5-year PFS rates were 96.8%and 56.3%,respectively(P<0.001).In the chemotherapy only group,the OS rates of patients aged<40,40-59,and≥60 years were 100.0%,75.0%,and 71.4%,respectively(P=0.048).There was no significant difference in OS in each age group(P=0.050).With respect to the Ann Arbor stage,the OS rates of patients aged<40,40-59,and≥60 years were 100%,88.90%,and 47.7%,respectively,in the advantage groups(P=0.046);however,there was no significant difference in the 5-year OS of the early group(stageⅠ+Ⅱ)at different age stratification(P=0.414).On univariate analysis,male sex was an adverse prognostic factor,and on multivariate analysis,male sex was correlated with a poorer PFS.Conclusions:The prognosis of patients with low-grade FL worsens with increasing age.Male sex is a poor prognostic factor.Administration of rituximab plus chemotherapy can improve the prognosis and prolong survival.
作者
吕柯冰
李鑫
左伟莉
马会敏
武晓龙
张明智
Kebing Lv;Xin Li;Weili Zuo;Huimin Ma;Xiaolong Wu;Mingzhi Zhang(Department of Oncology,The First Affiliated Hospital of Zhengzhou University,Lymphoma Diagnosis and Treatment Center,Zhengzhou 450052,China)
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2020年第16期811-816,共6页
Chinese Journal of Clinical Oncology
基金
国家自然科学基金面上项目(编号:8187010857)
2018年度河南省医学科技攻关计划省部共建项目(编号:SBGJ2018012)资助。
关键词
滤泡淋巴瘤
年龄
临床特点
预后
follicular lymphoma(FL)
age
clinical characteristics
prognosis
