Goto Naoe, Tsurumi Hisashi, Takemura Masao, Hara Takeshi, Sawada Michio, Kasahara Senji, Kanemura Nobuhiro, Yamada Toshiki, Shimizu Masahito, Takahashi Takeshi, Tomita Eiichi, Seishima Mitsuru, Takami Tsuyoshi, Moriwaki Hisataka
First Department of Internal Medicine, Gifu University School of Medicine, Gifu, Japan.
Eur J Haematol. 2006 Sep;77(3):217-25. doi: 10.1111/j.1600-0609.2006.00702.x. Epub 2006 Jul 19.
Recently investigators have worked to identify prognostic factors in non-Hodgkin's lymphoma (NHL) so an appropriate therapeutic plan can be put in action. The aim of the present study was to assess the prognostic significance of serum soluble tumor necrosis factor receptor (sTNF-R) 2 in aggressive NHL.
One hundred and ten consecutive patients with aggressive NHL who were previously untreated (diffuse large B-cell lymphoma; 94, peripheral T-cell lymphoma; 16) were prospectively enrolled in this study between 1997 and 2002. The patients were treated with 6-8 cycles of CHOP or THP-COP regimens.
High serum sTNF-Rs level was associated with some poor prognostic factors and low complete remission rate. Patients with high sTNF-R1 (4 ng/mL and over) and sTNF-R2 (15 ng/mL and over) at onset had significantly lower survival rates (5 yr: 19%, 19%) than those with low sTNF-R1 (under 4 ng/mL) and sTNF-R2 (under 15 ng/mL) (62% and 69%), respectively (P < 0.0005 and 0.0001). Multivariate analysis employing sTNF-R2 and some conventional prognostic factors demonstrated that a combination of sTNF-R2 and performance status, and that of sTNF-R2, sIL-2R, and LDH were significant prognostic factors for poor overall survival and for poor event-free survival, respectively. In addition, we attempted to use sTNF-R2 in combination with the international prognostic index (IPI). The patients in the high risk group and those with high sTNF-R2 in the low-intermediate (LI)/high-intermediate (HI) risk group had significantly lower survival rates than the patients in the low risk group and those with low sTNF-R2 in LI/HI risk group (P < 0.0001).
The results suggest that a high serum sTNF-R2 level predicts a poor prognosis in aggressive NHL and may be a useful biomarker for selecting appropriate treatment when used in combination with the IPI.
最近，研究人员致力于确定非霍奇金淋巴瘤（NHL）的预后因素，以便能够制定合适的治疗方案。本研究的目的是评估血清可溶性肿瘤坏死因子受体（sTNF-R）2在侵袭性NHL中的预后意义。
1997年至2002年间，前瞻性纳入了110例先前未经治疗的侵袭性NHL连续患者（弥漫性大B细胞淋巴瘤；94例，外周T细胞淋巴瘤；16例）。患者接受6 - 8个周期的CHOP或THP-COP方案治疗。
血清sTNF-Rs水平升高与一些不良预后因素及低完全缓解率相关。发病时sTNF-R1（4 ng/mL及以上）和sTNF-R2（15 ng/mL及以上）水平高的患者生存率（5年：19%，19%）显著低于sTNF-R1（低于4 ng/mL）和sTNF-R2（低于15 ng/mL）水平低的患者（分别为62%和69%）（P < 0.0005和0.0001）。采用sTNF-R2和一些传统预后因素的多因素分析表明，sTNF-R2与体能状态的组合，以及sTNF-R2、sIL-2R和LDH的组合分别是总生存期差和无事件生存期差的显著预后因素。此外，我们尝试将sTNF-R2与国际预后指数（IPI）联合使用。高危组患者以及低中危（LI）/高中危（HI）组中sTNF-R2水平高的患者生存率显著低于低危组患者以及LI/HI组中sTNF-R2水平低的患者（P < 0.0001）。
结果表明，血清sTNF-R2水平高预示侵袭性NHL预后不良，与IPI联合使用时可能是选择合适治疗方法的有用生物标志物。
