摘要
目的探讨HIV相关弥漫大B细胞淋巴瘤(DLBCL)患者的临床特征及预后。方法回顾性分析2008年7月至2021年8月重庆大学附属肿瘤医院确诊的63例HIV相关DLBCL患者的临床资料。生存分析采用Kaplan-Meier方法,组间生存的比较采用Log-rank检验,多因素分析采用Cox回归模型。结果63例患者中,男57例(90.5%),中位年龄49(23~87)岁。主要病理类型为生发中心来源(GCB),为47例(74.6%)。29例(46.0%)患者合并淋巴结外病变,17例(27.0%)患者合并大包块(最大直径≥7.5 cm),20例(31.7%)患者伴随B症状。CD4^(+)淋巴细胞中位数为203(4~1022)×10^(6)/L,49%(25/51)的患者CD4^(+)细胞数<200×10^(6)/L,51%(26/51)的患者CD4^(+)细胞数≥200×10^(6)/L。43.1%(25/58)的患者IPI评分0~2分,56.9%(33/58)的患者IPI评分3~5分。78%(46/59)的患者Ann Arbor分期Ⅲ/Ⅳ期。16例(25.4%)患者未接受化疗,14例(22.2%)患者接受小于4个周期的化疗,33例(52.4%)患者接受4个周期及以上的化疗。在接受化疗的患者中,61.7%(29/47)的患者采用R-CHOP样方案,38.3%(18/47)的患者采用CHOP样方案。总体患者的1、2、3和5年总生存(OS)率分别为65.0%、53.8%、47.1%和43.5%。单因素分析显示年龄≥60岁(P=0.012)、美国东部肿瘤协作组体能状况(ECOG-PS)评分2~4分(P=0.043)、IPI评分3~5分(P=0.001)、β_(2)-微球蛋白升高(P=0.007)和全身化疗周期数<4(P<0.001)为影响患者OS的不良预后因素。Cox多因素分析显示年龄≥60岁(HR=2.272,95%CI 1.110~4.651,P=0.025)、IPI评分3~5分(HR=3.562,95%CI 1.794~7.074,P<0.001),ECOG-PS评分2~4分(HR=2.675,95%CI 1.162~6.153,P=0.021)和化疗周期数<4(HR=0.290,95%CI 0.176~0.479,P<0.001)为影响OS的预后危险因素。结论HIV相关DLBCL是最常见的HIV相关肿瘤,男性多见,1年内病死率高,化疗联合抗逆转录病毒治疗可显著改善患者预后。
Objective This study aimed to look into the clinical characteristics and prognosis of patients with human immunodeficiency virus(HIV)-associated diffuse large B-cell lymphoma(DLBCL).Methods Retrospective review of the clinical data of 63 HIV-infected patients with DLBCL diagnosed at Chongqing University Cancer Hospital between July 2008 and August 2021.The Kaplan-Meier method was used to calculate survival curves,and the log-rank test method was used to compare survival between groups.The Cox proportional hazards model was used for multivariate analysis.Results In 63 patients with HIV-associated DLBCL,57(90.5%)were men,and the median age was 49(23-87)years.The most common pathological subtype was the germinal center B-cell-like lymphoma(74.6%);46.0%(29/63)were combined with extranodal lesions.Seventeen of 63(27.0%)patients had large masses(≥7.5 cm).Twenty of 63(31.7%)patients had B symptoms.The median CD4^(+)T cell count was 203(4-1022)×10^(6)/L.A total of 49%(25/51)patients had CD4^(+) cell count<200×10^(6)/L,56.9%(33/58)had high(3-5)International Prognostic Index(IPI)scores,and 43.1%(25/58)had low(0-2)IPI scores.Further,78%(46/59)were diagnosed with Ann Arbor Stage Ⅲ/Ⅳ,and 25.4%(16/63)didn't receive chemotherapy.A total of 22.2%(14/63)of patients received less than four cycles of chemotherapy,and 52.4%(33/63)received four or more cycles of chemotherapy.Among patients undergoing chemotherapy,61.7%(29/47)received R-CHOP-like regimens,and 38.3%(18/47)used CHOP-like regimens.The 1-,2-,3-,and 5-year overall survival(OS)rates were 65.0%,53.8%,47.1%,and 43.5%,respectively.Univariate analysis revealed that age≥60 years(P=0.012),Eastern Cooperative Oncology Gruop Performance Status(ECOG-PS)score 2-4 points(P=0.043),IPI score 3-5 points(P=0.001),β_(2)-MG elevation(≥5.5 mg/L)(P=0.007),and systemic chemotherapy cycles less than four times(P<0.001)were the negative prognostic factors affecting the OS of patients.The Cox multivariate analysis depicted that age≥60 years(HR=2.272,95%CI 1.110-4.651,P=0.025),IPI score 3-5 points(HR=3.562,95%CI 1.794-7.074,P<0.001),ECOG-PS score 2-4 points(HR=2.675,95%CI 1.162-6.153,P=0.021),and number of cycles of chemotherapy<4(HR=0.290,95%CI 0.176-0.479,P<0.001)were independent risk factors for adverse prognosis of OS.Conclusion HIV-associated DLBCL is the most common HIV-related tumor,is most commonly seen in men,and has a high 1-year mortality rate.Chemotherapy combined with antiretroviral therapy can improve patient prognosis.
作者
王超雨
刘俊
梁喜平
郭冰凌
胡人之
刘耀
Wang Chaoyu;Liu Jun;Liang Xiping;Guo Bingling;Hu Renzhi;Liu Yao(Department of Hematology-Oncology,Chongqing University Cancer Hospital,Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment,Chongqing 400030,China)
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2022年第3期203-208,共6页
Chinese Journal of Hematology
基金
国家自然科学基金(81670100)。
关键词
淋巴瘤
大B细胞
弥漫性
人类免疫缺陷病毒
获得性免疫缺陷综合征
临床特征
预后
Lymphoma,large B-cell,diffuse
Human immunodeficiency virus
Acquired immune deficiency syndrome
Clinical characteristics
Prognosis
