弥漫大B细胞淋巴瘤早期疗效及相关因素初步分析

发布时间：2018-07-24 19:35

【摘要】：目的:分析弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)患者临床资料,探讨其早期疗效及相关影响因素。方法:回顾分析遵义医学院附属医院2007年1月到2017年1月收治的经病理及免疫组化确诊的156例DLBCL患者病例资料。观察其完成2个疗程CHOP或R-CHOP方案的治疗效果。采用t检验或c2检验对患者年龄、性别、临床分期、结外器官累及情况、骨髓幼稚淋巴细胞百分比、Bcl-2、Ki-67表达水平以及治疗方案的选择等进行单因素分析;对影响早期治疗效果的多种因素采用二分类非条件Logistic回归分析;并对不同独立危险因素组组间疗效进行分层分析。结果:(1)本组156例DLBCL患者,男性99例,女性57例,男女比例1.74:1。其中采用CHOP方案95例,R-CHOP方案61例,治疗有效106例,治疗无效50例,有效率为67.9%。(2)单因素分析各因素与早期疗效的关系:(1)年龄￡60岁患者的治疗有效率为72.4%,年龄(29)60岁的有效率为55.0%,两组比较有统计学差异(P0.05);(2)临床分期I期+II期患者的治疗有效率为76.7%,III期+IV期的有效率为57.1%,两组比较有统计学差异(P0.05);(3)结外器官累及数目￡1的患者治疗有效率为76.3%,数目1的有效率为42.1%,两组比较有统计学差异(P0.05);(4)Ki-67低表达患者的治疗有效率为76.9%,高表达的有效率为47.9%,两组比较有统计学差异(P0.05);(5)选用R-CHOP治疗的有效率为83.6%(51/61),CHOP治疗的有效率为57.9%(55/95),两组比较有统计学差异(P0.05);(6)不同性别、骨髓幼稚淋巴细胞百分比及Bcl-2表达情况比较无统计学差异(P(29)0.05)。(3)将年龄、临床分期、结外器官累及情况、Ki-67表达水平及治疗方案的选择纳入二分类非条件Logistic回归分析显示:临床分期和Ki-67表达水平是影响早期疗效的独立危险因素(P0.05,OR1)。(4)不同临床分期、Ki-67表达水平的CHOP组及R-CHOP组早期疗效分析:III期+IV期患者使用R-CHOP治疗方案早期有效率明显高于CHOP方案(84.6%与40.9%),两者之间有统计学差异(P0.05);I期+II期患者两种治疗方案早期有效率比较无统计学差异(P(29)0.05);不同Ki-67表达组两种治疗方案早期有效率比较无统计学差异(P(29)0.05)。结论:(1)临床分期、Ki-67表达水平是影响DLBCL患者治疗效果的独立危险因素。(2)对于DLBCL患者,早发现、早诊断、早治疗并对III期+IV期患者及时使用含利妥昔单抗方案(R-CHOP)治疗能改善疗效,对于I期+II期患者在条件受限时CHOP方案仍可作为最初的治疗观察。(3)目前对Ki-67的检测方法及判断阈值有待进一步研究。
[Abstract]:Objective: to analyze the clinical data of patients with diffuse large B cell lymphoma (diffuse large B-cell lymphoma DLBCL) and to explore the early curative effect and related factors. Methods: the data of 156 cases of DLBCL diagnosed by pathology and immunohistochemistry from January 2007 to January 2017 in affiliated Hospital of Zunyi Medical College were retrospectively analyzed. To observe the effect of two courses of CHOP or R-CHOP regimen. T test and c 2 test were used to analyze the age, sex, clinical stage, involvement of extranodular organs, percentage of immature bone marrow lymphocytes and the expression of Bcl-2Ki 67 and the choice of treatment plan. The factors influencing the effect of early treatment were analyzed by two-classification non-conditional Logistic regression analysis and stratified analysis among groups with different independent risk factors. Results: (1) among the 156 DLBCL patients, 99 were male and 57 were female, the ratio of male to female was 1.74: 1. Among them, 95 cases were treated with CHOP regimen, 61 cases were treated with R-CHOP regimen, 106 cases were effective and 50 cases were ineffective. The effective rate was 67.9%. (2) the relationship between the factors and the early curative effect was analyzed by univariate analysis: (1) the effective rate of treatment was 72.4 for patients aged 60 and 55.0 for those aged (29) 60. There was statistical difference between the two groups (P0.05); (2). The effective rate of treatment was 76.7% and the effective rate of stage IV was 57.1. There was a significant difference between the two groups (P0.05); (3). The effective rate of treatment was 76.3G and the effective rate of number 1 was 42.1%. There was statistical difference between the two groups (P0.05); (4) Ki-67 low table. The effective rate of treatment was 76. 9% and that of high expression was 47. 9%. There was significant difference between the two groups (P0.05); (5). The effective rate of using R-CHOP treatment was 83.6% (51 / 61). The effective rate of chop treatment was 57.9% (55 / 95). There was statistical difference between the two groups (); (. 05. 6). There was no significant difference in the percentage of immature lymphocytes and the expression of Bcl-2 in bone marrow (P (29) 0.05). (3) age and clinical stage. The expression of Ki-67 and the choice of treatment regimen in extranodal organ involvement were included in two categories of non-conditional Logistic regression analysis: clinical stage and Ki-67 expression level were independent risk factors (P0.05 OR1). (4) for early curative effect (P0.05 OR1). (4) and Ki-67 table for different clinical stages was included in the regression analysis of non-conditional Logistic analysis. Early effective rate of R-CHOP regimen in CHOP and R-CHOP patients with stage III stage IV was significantly higher than that of CHOP regimen (84.6% vs 40.9%). There was a significant difference between the two groups (P0.05). There was no significant difference in efficiency (P (29), and there was no significant difference (P (29) in the early effective rate between the two treatment schemes in different Ki-67 expression groups (P < 0. 05). Conclusion: (1) the expression of Ki-67 in clinical stage is an independent risk factor for the treatment effect of DLBCL patients. (2) for DLBCL patients, early detection, early diagnosis, early treatment and timely use of rituximab regimen (R-CHOP) in III stage IV patients can improve the curative effect. CHOP regimen can still be used as the initial therapeutic observation for stage I patients with limited conditions. (3) at present, the detection method and threshold of Ki-67 need to be further studied.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.1

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