【作者】 陈丽燕；

【导师】 刘庭波；

【作者基本信息】 福建医科大学 ， 内科学（血液）， 2017， 硕士

【摘要】 目的:探究化疗前血清白蛋白水平对接受化疗的弥漫大B细胞淋巴瘤患者远期预后评估的价值。方法:回顾性分析2010年1月1日至2014年12月31日福建医科大学附属协和医院收治的127例DLBCL初治患者。统计该研究组患者的性别、年龄、Ann Arbor分期、ECOG评分、实验室检查、治疗方案、国际预后指数、缓解率、总生存时间、无病生存时间等因素。ROC曲线分析法获得血清白蛋白的最佳临界值。单因素和多因素生存分析法分析影响DLBCL患者总体生存时间的相关因素。Kaplan-Meier法绘制相关影响因素的生存函数曲线。结果:本研究共纳入127名患者,其中男性71例(55.9%),女性56例(44.1%),男:女=1.3:1,中位年龄56(18-86)岁;一般临床特征:ECOG≥2分22例(17.3%),伴随B症状45例(35.4%),LDH增高67例(52.8%),SA≤34g/L70例(55.1%),结外累及69例(54.3%),骨髓累及32例(25.2%),病理为生发中心B细胞样45例(35.4%),病理为非生发中心B细胞样81例(63.8%),Ann Arbor分期I-II 41例(32.3%),Ann Arbor分期III-IV 86例(67.7%)。中位随访时间25(0-66)个月,中位OS未达到,中位PFS为21个月,1年、3年及5年OS分别为70.3%、61.0%、50.5%,1年、3年及5年PFS率分别为56.7%、41.2%、32.0%。单因素分析结果显示:SA≤34g/L、Ann Arbor III-IV期、伴随B症状、LDH增高、ECOG≥2分、骨髓累及提示DLBCL患者预后不良;性别、年龄、病理分型对患者预后影响不大。远期疗效分析提示R-CHOP样方案组患者的OS优于CHOP样方案组,差异有统计学意义(P=0.003)。K-M发分析第一次治疗前和第二次治疗前的变化,可知:SA持续>34 g/L组患者较SA持续≤34 g/L组患者有更长的OS,差异有统计学意义(P=0.020);第一次SA水平相同,第二次SA的变化无统计学意义,不能说明第二次SA的变化存在OS差异。IPI/aa IPI可用于评估DLBCL患者的危险分层(P=0.003),NCCN-IPI也可用于评估DLBCL患者的危险分层(P=0.000)。多因素分析表明SA≤34g/L(HR=0.48,95%CI=0.26-0.90,P=0.022)是影响DLBCL患者预后的独立危险因素;R-CHOP样治疗方案(HR=0.43,95%CI=0.24-0.76,P=0.004)也是影响DLBCL患者预后的独立因素。结论:本研究显示:化疗前血清白蛋白可作为DLBCL患者预后评估的一项指标,血清白蛋白低于34g/L提示预后不良。化疗前低SA提示较低OS,此结果不受第二次化疗前SA水平影响。更多还原

【Abstract】 Object To investigate the value of serum albumin level before chemotherapy in patients with diffuse large B cell lymphoma receiving chemotherapy.Methods A retrospective analysis of 127 patients with DLBCL treated in the Fujian Medical University Union Hospital from January 1st,2010 to December 31 st,2014.The gender,age,Ann Arbor stage,ECOG score,laboratory examination,treatment protocol,international prognostic index,remission rate,overall survival time,and disease-free survival time were analyzed.The optimal threshold value of serum albumin was obtained by ROC curve analysis.Univariate and multivariate survival analysis to analyze the factors affecting the overall survival time of DLBCL patients.Kaplan-Meier method to draw the survival function curve.Result In this study 127 patients,including 71 cases of male(55.9%),56 cases of female(44.1%),male: female =1.3:1;the median age was 56 years old(18-86);clinical characteristics: ECOG more than one score 22 cases(17.3%),45 cases(35.4%)with B symptoms,LDH increased in 67 cases(52.8%),SA within 34g/L 70 cases(55.1%),extranodal involvement in 69 cases(54.3%),32 cases(25.2%)of bone marrow involvement,germinal center B cell like in 45 cases(35.4%),non germinal center B cell like in 81 cases(63.8%),Ann Arbor I-II in 41 patients(32.3%),Ann Arbor III-IV in 86 patients(67.7%).Median follow-up was 25(0-66)months,the median OS was not reached,the median PFS was 21 months,one year’s,three years’ and five years’ OS were 70.3%,61%,50.5%;one year’s,three years’ and five years’ PFS were 56.7%,41.2%,32%.Univariate analysis showed that the SA no more than 34g/L,the increase of LDH,Ann Arbor III-IV,with B symptoms,ECOG more than one score,bone marrow involvement suggesting that DLBCL patients with poor prognosis;gender,age,pathological type has little effect on the prognosis of DLBCL patients.Long term efficacy analysis showed that the OS of the R-CHOP group was better than that of the CHOP group,the difference was statistically significant(P=0.003).Kaplan-Meier analysis of the changes,the first time and second times before treatment showed that SA for >34 g/L patients in the group compared with SA for less than or equal to 34 patients in the g/L group had a longer OS,the difference was statistically significant(P=0.020);with the same first SA level,change of second time SA without statistical significance,can not say that there is OS difference in changes of the second time SA.IPI/aa IPI can be used to assess risk stratification(P=0.003)in patients with DLBCL,and NCCN-IPI may also be used to assess risk stratification(P=0.000)in patients with DLBCL.Multivariate analysis showed that SA≤34g/L was independent prognostic factor in DLBCL patients(HR=0.48,95%CI=0.26-0.90,P=0.022);R-CHOP sample treatment was also the independent prognostic factor in DLBCL patients(HR=0.43,95%CI=0.24-0.76,P=0.004).Conclusion This study shows that serum albumin before chemotherapy can be used as the evaluation of the prognosis of patients with DLBCL,serum albumin was lower than 34g/L indicates a poor prognosis.Low SA before chemotherapy showed lower OS,which was not affected by the level of SA before the second chemotherapy.更多还原