【摘要】 本研究探讨老年非霍奇金淋巴瘤(non-Hodgkin’s lymphoma,NHL)的临床病理学特征、疗效和预后相关因素。对2003年1月-2012年12月中国人民解放军总医院老年血液科收治的30例老年NHL患者的临床资料进行回顾性分析,包括患者的一般临床特征、病理特点、化疗方案选择及临床反应,并运用Kaplan-Meier曲线进行生存分析,应用COX回归模型对相关预后因素(包括年龄、IPI评分、B组症状、Ann-Arbor分期和LDH水平)进行多变量分析。结果表明,30例患者中位年龄82.5岁;所有患者均有合并症,其中以心血管系统疾病(包括高血压、冠心病、心律失常等)最常见,少数(8/30)合并第二肿瘤;出现B组症状的占63%(19/30);病理分型中仅2例为T细胞淋巴瘤,其余为B细胞淋巴瘤,其中弥漫大B细胞淋巴瘤占所有B细胞淋巴瘤的57%(17/28);Ann-Arbor分期Ⅰ-Ⅱ期占37%(11/30),Ⅲ-Ⅳ期占63%(19/30);IPI评分2分以下10例,3分4例,4-5分16例,3-5分的患者占67%(20/30);初诊时有43%(13/30)患者的LDH高于正常。全组病例均采用改良R-CHOP为基础的个体化方案化疗,4个疗程后CR 14例,PR 13例,PD 2例,SD 1例,治疗总反应率为90%;全组病例1年、2年总生存率分别为73.3%、43.3%;半年、1年无进展生存率分别为62.2%、54.9%;COX回归多变量分析显示,B组症状和Ann-Arbor分期是影响老年NHL生存的独立预后因素(P=0.014、0.039;RR=6.678、4.939)。结论:老年NHL患者症状不典型,初诊时分期较晚,合并基础疾病多,由于个体差异大,应根据不同预后采取个体化治疗;以脂质体阿霉素为基础的CHOP方案对心脏的毒性低,对老年NHL可能是一种安全有效的方案;老年NHL患者无B组症状和Ann-Arbor分期≤Ⅱ期是老年NHL患者预后良好的指标。更多还原

【Abstract】 The purpose of this study was to explore the clinicopathological features,therapy and prognostic factors of elderly patients with non-Hodgkin’ s lymphoma( NHL). The clinical data including general clinical characteristics, pathological features,chemotherapy selection and treatment response of 30 patients with NHL in our hospital from January 2003 to December 2012 were analyzed retrospectively. The survival was analyzed by using Kaplan-Meier methods,and the prognosis was evaluated by COX regression multivariate analysis model. The clinical parameters selected include age, Ann Arbor stage,international prognostic index( IPI),B symptom and lactate dehydrogenase( LDH) levels. The results showed that all the patients suffered from underlying disease,and the cardiovascular disease( hypertension,coronary heart disease,arrhythmia) is the most common,and minority( 8 /30) combined with secondary tumor,the 63%( 19 /30) cases had B symptoms at diagnosis. only 2 cases were diagnosed as T-cell lymphoma; the 93%( 28 /30) cases combined with Bcell lymphoma,57%( 17 /28) of them combined with diffuse large B-cell lymphoma. Ann-Arbor stage≤Ⅱwas 37%( 11 / 30); 10( 37%) patient’s IPI score was ≤2,and 67%( 20 /30) was scored 35; 13( 43%) patient’s serum LDH level was abnormal. Modified R-CHOP chemotherapy was given individually on the basis of clinical features. The patients achieved complete remission,partial remission,stable disease,or progressive disease accounted for 14( 46. 7%),13( 43. 3%),1( 3. 3%),and 2( 6. 7%),respectively; the total reaction rate was 90% after 4 cycles of chemotherapy; the overall survival( OS) rate at 1 and 2 years was 73. 3% and 43. 3%,and progression-free survival( PFS) rate at 0. 5 and 1 years was 62. 2% and 54. 9%; multivariate analysis by COX regression showed that B symptoms and Ann-Arbor stage were independent factors( P = 0. 014,0. 039; RR = 6. 678,4. 939,respectively) affecting the OS of elderly NHL,and IPI score affected PFS independently. It is concluded that elderly patients with NHL usually are of late stage at newly diagnosis and have suffered from underlaying diseases. Besides strengthening supportive treatment,modified R-CHOP chemotherapy should be given individually according to different prognosis. B symptoms and Ann-Arbor stage > Ⅱare indicators for poor prognosis of elderly NHL.更多还原