Wang Hai-Tao, Yang Bo, Cai Li-Li, Ran Hai-Hong, Zhang Wen-Ying, Zhu Hong-Li, Yang Yang, Li Su-Xia, Fan Hui, Chi Xiao-Hua, Yu Rui-Li, Zhang Feng, Li Bao-Ling, Lin Jie, Zhai Bing, Yao Shan-Qian, Lu Xue-Chun
Department of Geriatric Hematology, Chinese PLA General Hospital, Beijing 100853, China.
Department of Geriatric Laboratorial Medicine, Chinese PLA General Hospital, Beijing 100853, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2013 Dec;21(6):1464-70. doi: 10.7534/j.issn.1009-2137.2013.06.018.
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 B-cell 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 3-5; 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 >II are indicators for poor prognosis of elderly NHL.
本研究旨在探讨老年非霍奇金淋巴瘤（NHL）患者的临床病理特征、治疗方法及预后因素。回顾性分析了2003年1月至2012年12月我院收治的30例NHL患者的临床资料，包括一般临床特征、病理特征、化疗方案选择及治疗反应。采用Kaplan-Meier法分析生存情况，通过COX回归多因素分析模型评估预后。选取的临床参数包括年龄、Ann Arbor分期、国际预后指数（IPI）、B症状及乳酸脱氢酶（LDH）水平。结果显示，所有患者均患有基础疾病，其中心血管疾病（高血压、冠心病、心律失常）最为常见，少数（8/30）合并继发性肿瘤，63%（19/30）的病例在诊断时有B症状。仅2例诊断为T细胞淋巴瘤；93%（28/30）的病例合并B细胞淋巴瘤，其中57%（17/28）合并弥漫大B细胞淋巴瘤。Ann-Arbor分期≤Ⅱ期的占37%（11/30）；10例（37%）患者的IPI评分≤2，67%（20/30）评分为3 - 5分；13例（43%）患者血清LDH水平异常。根据临床特征个体化给予改良R-CHOP化疗。患者达到完全缓解、部分缓解、病情稳定或疾病进展的分别占14例（46.7%）、13例（43.3%）、1例（3.3%）和2例（6.7%）；化疗4周期后总有效率为90%；1年和2年的总生存（OS）率分别为73.3%和43.3%，0.5年和1年的无进展生存（PFS）率分别为62.2%和54.9%；COX回归多因素分析显示，B症状和Ann Arbor分期是影响老年NHL患者OS的独立因素（P = 0.014，0.039；RR分别为6.678，4.939），IPI评分独立影响PFS。结论：老年NHL患者初诊时多为晚期且伴有基础疾病。除加强支持治疗外，应根据不同预后个体化给予改良R-CHOP化疗。B症状和Ann Arbor分期>Ⅱ期是老年NHL预后不良的指标。
