94例滤泡性淋巴瘤患者的临床特征及预后因素分析

Abstract

目的:探讨滤泡性淋巴瘤的临床特征、疗效及预后因素.方法:对94例滤泡性淋巴瘤患者的临床资料进行回顾性分析,统计分析该组患者的临床特征、实验室化验指标、治疗方案及疗效、生存及预后因素.结果:94例滤泡性淋巴瘤患者多为中老年起病,中位发病年龄50.5岁,女性多见,男女比例为1∶1.35;72.3％的患者以发现浅表淋巴结肿大为首发症状,25.5％的患者起病时存在B症状;57 4％起病时即存在结外器官侵犯,其中以骨髓侵犯最为常见,占36.2％;BCL-2/IGH基因重排的检测阳性率为33.9％,FL 3级的患者占24.5％;起病时Ⅲ-Ⅳ期为71.3％;87例可追踪并可评价疗效的患者,ORR为92.0％,其中CR率为79.3％,复发率为35.2％,其3、5和10年OS分别92.1％,84.6％和77.4％,3、5和10年PFS分别为68.5％,61.4％和41.9％;应用美罗华组患者累积OS及PFS均较未应用组患者改善,但二者并无统计学差异(P＞0.05);单因素分析显示,FL分期、ECOG评分、白蛋白、乳酸脱氢酶、消化道受累、初治是否达CR对患者OS有显著影响(P＜0.05);多因素分析显示,消化道受累与否、初治是否达CR是OS的独立危险因素(P＜0.05);单因素分析显示:BCL-2、CD10、ECOG评分、白蛋白、淋巴细胞百分数是否正常、血红蛋白、血沉、LDH正常与否、消化道受累与否对FL患者PFS有显著影响(P＜0.05);而多因素生存分析显示初治是否CR、有无消化道受累、LDH正常与否、ECOG评分为PFS的独立危险因素(P＜0.05).结论:FL多见于中老年女性,确诊时多为晚期,骨髓受累常见.CD10阴性为FL预后不良因素.消化道受累与否,初治是否达CR是影响OS的独立危险因素,初治是否CR、有无消化道受累、LDH正常与否、ECOG评分为PFS的独立危险因素.

OBJECTIVE: To investigate the clinical manifestation, therapeutic efficacy and related prognostic factors of patients with follicular lymphoma.; METHODS: A retroretrospective study was conducted on 94 patients with follicular lymphoma who were admitted to our hospital from March 1999 to June 2016. The total of 94 newly diagnosed FL patients were analyzed in terms of clinical manifestation, laboratory data, pathological examination, clinical stage and so on, so as to find out the related prognostic factors.; RESULTS: Ninety-four patients were included in this study. The median age at onset was 50.60 years old, more common in women, and ratio of male to female was 1:1.35. The superficial lymphadenopathy was found to be the first symptom in 72.3% patients, 25.5% patients had B symptoms when diagnosed, 57.4% cases had extranodal organ invasion when diagnosed, of which bone marrow invasion is the most common, accounting for 36.2%, followed by the digestive tract, bone, spleen and so on. The detected rate of BCL-2 / IGH gene rearrangement was 33.9%. Patients with grade 3 of FL accounted for 24.5%. Cases of clinical stage III-IV accounted for 71.2% in these FL patients. The overall response rate (ORR) was 92.0%, and the complete remission (CR) rate was 79.3% and the recurrence rate was 35.2%. The cumulative overall survival rates of 3, 5 and 10 years were 92.1% , 84.6% and 77.4% respectively, and the cumulative progression-free survival(PFS) rate in 3,5 and 10 years was 68.5%, 61.4% and 41.9%, respectively. The results showed that the CR rate was 85.2% in patients treated with rituximab and 69.7% in patients treated without rituximab. The OS and PFS in patients treated with rituximab were better than those in patients treated without rituximab, but there was no significant difference between them(P>0.05). Univariate analysis showed that FL stage, ECOG score, Hb and LDH levels, digestive tract involvement or not, CR or not after initial treatment had a significant impact on OS(P<0.05), while BCL-2, CD10, ECOG score, albumin, Hb and LDH levels, percentage of lymphocytes, erythrocyte sedimentation rate, digestive tract involvement had a significant impact on PFS (P<0.05). Multivariate analysis showed that digestive tract involvement or not, CR or not after initial treatment were independent risk factors for OS(P<0.05), while CR or not after initial treatment, digestive tract invdvement or not, LDH level and ECOG score were independent risk factors for PFS(P<0.05).; CONCLUSION: The FL is more common in middle-aged women, the FL was in late stage at confirmed diagnosis, bone marrow involvement is more common. The CD10 negative is poor prognostic factor for FL. The digestive tract involvement or not, CR or not after initial treatment are independent risk factors for OS, while CR or not after initial treatment, digestive tract involvement or not, LDH level and ECOG score are independent risk factors for PFS.