霍奇金淋巴瘤患者临床特征及预后相关因素分析

发布时间：2018-04-22 17:19

  本文选题：霍奇金淋巴瘤 + 预后　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的:回顾性分析初发未治霍奇金淋巴瘤(Hodgkin lymphoma,HL)患者的临床特征,评估其治疗效果,并进行预后相关因素分析。方法:本研究为单中心的回顾性研究,收集2010年1月至2016年10月期间就诊于浙江大学医学院附属第一医院的初发未治霍奇金淋巴瘤病例,共154例。回顾性分析患者的临床特征,评估其治疗效果,采用Kaplan-Meier单因素生存分析及COX比例风险回归模型进行预后相关因素分析。结果:(1)154例HL患者年龄14-80岁,中位年龄36.5岁,男性患者92例(59.7%),女性62例(40.3%)。至随访截止时间,9例(5.8%)患者死亡,145例(94.2%)患者生存。所有患者接受ABVD或AVD方案化疗,中位6个疗程。治疗总反应率为91.6%(141例),复发率20.1%(31例)。154例HL患者中位无进展生存时间(progression-free survival,PFS)22.5个月,其中47例复发或疾病进展的HL患者中位PFS为12个月。(2)男性(P=0.016)、B 症状(P0.001)、Ⅲ-Ⅳ期(P=0.04)、IPI≥2 分(P=0.032)和C反应蛋白25mg/L(P=0.004)的HL患者3年PFS率显著降低。HL患者中伴有B症状组1年PFS率明显低于无B症状组(P=0.001)。(3)单因素生存分析结果显示:男性(P=0.004)、B症状(P0.001)、Ⅲ-Ⅳ期(P=0.006)、IPI 评分≥2 分(P=0.001)、IPS 评分2 分(P=0.006)、淋巴细胞计数0.6×109/L(P=0.004)、C 反应蛋白25mg/L(P=0.001)、乳酸脱氢酶280μmol/L(P=0.013)的患者无进展生存时间显著缩短,有统计学意义。(4)多因素生存分析结果显示:男性(HR2.309,95%CI1.131-4.714,P=0.022)、有B症状(HR 2.659,95%CI 1.280-5.524,P=0.009)的HL患者无进展生存时间显著缩短,表明男性和B症状是HL患者的不良预后因素。(5)Ⅰ-Ⅱ期患者54例(35.1%),Ⅲ-Ⅳ期患者100例(64.9%)。两组患者的总生存率分别为98.1%、92%,无统计学意义(P=0.121)。Ⅰ-Ⅱ期患者3年PFS率显著高于Ⅲ-Ⅳ期患者(83.3%vs68%,P=0.04)。在Ⅲ-Ⅳ期患者中,男性、B症状和淋巴细胞计数0.6×109/L的患者无进展生存时间缩短,有统计学意义。结论:HL患者总体预后良好。男性、B症状是影响HL患者无进展生存时间的独立不良预后因素;对于Ⅲ-Ⅳ期HL患者,男性、B症状和淋巴细胞计数0.6×109/L是影响无进展生存时间的不良预后因素。
[Abstract]:Objective: to retrospectively analyze the clinical features of patients with primary untreated Hodgkin lymphoma (Hodgkin lymphoma), evaluate the therapeutic effect and analyze the prognostic factors. Methods: a single center retrospective study was conducted to collect 154 cases of untreated Hodgkin's lymphoma from January 2010 to October 2016 in the first affiliated Hospital of Zhejiang University Medical College. The clinical features of the patients were analyzed retrospectively and the therapeutic effects were evaluated. The prognostic factors were analyzed by Kaplan-Meier single factor survival analysis and COX proportional risk regression model. Results the age of 154 cases of HL was 14-80 years old, the median age was 36.5 years old, 92 cases of male patients were 59.7%, 62 cases of female patients were 40.3%. At the end of follow-up, 9 patients died and 145 patients died (94. 2%). All patients received ABVD or AVD regimen chemotherapy, a median of 6 courses. The total response rate of the treatment was 91.6% and 141 cases, and the recurrence rate was 20.1%. The median progression-free survival time was 22.5 months in 31 cases with HL and 154 cases with HL. The median PFS of 47 patients with recurrent or progressive HL was 12 months. (2) male patients with P0. 016 / B symptom P 0.001, stage 鈪，

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