血液嗜酸性粒细胞增多在原发性皮肤T细胞淋巴瘤中的预后价值。

Prognostic value of blood eosinophilia in primary cutaneous T-cell lymphomas.

作者信息

Tancrède-Bohin Emmanuelle, Ionescu Marius Anton, de La Salmonière Pauline, Dupuy Alain, Rivet Jacqueline, Rybojad Michel, Dubertret Louis, Bachelez Hervé, Lebbé Celeste, Morel Patrice

机构信息

Department of Dermatology 2, Hôpital Saint-Louis, Paris, France.

出版信息

Arch Dermatol. 2004 Sep;140(9):1057-61. doi: 10.1001/archderm.140.9.1057.

DOI:10.1001/archderm.140.9.1057

PMID:15381544

Abstract

OBJECTIVE

To investigate the prognostic value of initial characteristics including blood eosinophilia in patients with primary cutaneous T-cell lymphoma.

DESIGN

A retrospective inception cohort, patients included from date of diagnosis (1982-1998).

SETTING

Two dermatology departments of a university hospital. Patients A total of 104 patients with cutaneous T-cell lymphoma, including patients with mycosis fungoides (n = 69), Sézary syndrome (n = 13), and nonepidermotropic cutaneous lymphoma (n = 22). The following variables were recorded: age, sex, diagnosis according to the European Organization for Research and Treatment of Cancer (EORTC) classification, type of skin involvement at the time of diagnosis, initial eosinophil absolute count, lactate dehydrogenase value, date of disease progression, and cause and date of death or date of last contact.

MAIN OUTCOME MEASURES

Time from diagnosis to disease progression and to disease-specific death.

RESULTS

The median follow-up was 43 months (range, 7-197 months). Estimated rates of disease progression and disease-specific death for 3 years were 19.5% (95% confidence interval [CI],11.3%-27.6%) and 9.9% (95% CI, 2.8%-13.6%), respectively. Univariable analysis of initial variables possibly influencing disease progression revealed significant prognostic value for diagnosis according to EORTC classification (hazard ratio [HR], 2.77; 95% CI, 1.04-7.41; P =.04), type of skin involvement (HR, 2.70; 95% CI, 1.00-7.25; P =.04), raised blood eosinophil absolute count (HR, 7.33; 95% CI, 2.84-18.91; P<.001), and raised serum level of lactate dehydrogenase (HR, 3.72; 95% CI, 1.58-8.78; P =.001). Concerning disease-specific death, significant prognostic indicators were diagnosis according to the EORTC classification (HR, 6.62; 95% CI, 1.68-26.12; P =.007) and a raised blood eosinophil absolute count (HR, 10.57; 95% CI, 2.28-49.0; P<.001). In multivariable analysis, only blood eosinophilia was associated with disease progression and disease-specific death.

CONCLUSION

These results strongly suggest that blood eosinophilia at baseline is a prognostic factor in patients with primary cutaneous T-cell lymphoma.

摘要

目的

探讨包括血液嗜酸性粒细胞增多在内的初始特征对原发性皮肤T细胞淋巴瘤患者的预后价值。

设计

一项回顾性起始队列研究，患者自诊断日期（1982 - 1998年）纳入。

地点

一所大学医院的两个皮肤科。患者共104例皮肤T细胞淋巴瘤患者，包括蕈样肉芽肿患者（n = 69）、 Sézary综合征患者（n = 13）和非亲表皮性皮肤淋巴瘤患者（n = 22）。记录了以下变量：年龄、性别、根据欧洲癌症研究与治疗组织（EORTC）分类的诊断、诊断时皮肤受累类型、初始嗜酸性粒细胞绝对计数、乳酸脱氢酶值、疾病进展日期、死亡原因及日期或最后一次接触日期。

主要观察指标

从诊断到疾病进展和疾病特异性死亡的时间。

结果

中位随访时间为43个月（范围7 - 197个月）。3年的疾病进展和疾病特异性死亡估计发生率分别为19.5%（95%置信区间[CI]，11.3% - 27.6%）和9.9%（95% CI，2.8% - 13.6%）。对可能影响疾病进展的初始变量进行单变量分析显示，根据EORTC分类的诊断具有显著预后价值（风险比[HR]，2.77；95% CI，1.04 - 7.41；P = 0.04）、皮肤受累类型（HR，2.70；95% CI，1.00 - 7.25；P = 0.04）、血液嗜酸性粒细胞绝对计数升高（HR，7.33；95% CI，2.84 - 18.91；P < 0.001）以及血清乳酸脱氢酶水平升高（HR，3.72；95% CI，1.58 - 8.78；P = 0.001）。关于疾病特异性死亡，显著的预后指标是根据EORTC分类的诊断（HR，6.62；95% CI，1.68 - 26.12；P = 0.007）和血液嗜酸性粒细胞绝对计数升高（HR，10.57；95% CI，2.28 - 49.0；P < 0.001）。在多变量分析中，只有血液嗜酸性粒细胞增多与疾病进展和疾病特异性死亡相关。