类风湿关节炎相关淋巴增生性疾病患者的总生存和自发性缓解后无复发生存：一项多中心回顾性队列研究。

Overall survival and post-spontaneous regression relapse-free survival of patients with lymphoproliferative disorders associated with rheumatoid arthritis: a multi-center retrospective cohort study.

机构信息

Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

出版信息

Mod Rheumatol. 2022 Jan 5;32(1):50-58. doi: 10.1080/14397595.2020.1866837.

DOI:10.1080/14397595.2020.1866837

PMID:33336615

Abstract

OBJECTIVES

To clarify factors affecting 5-year survival rates and relapse rates after spontaneous regression (SR) of lymphoproliferative disorders (LPDs) in patients with rheumatoid arthritis (RA).

METHODS

This retrospective longitudinal study comprised 232 patients with RA diagnosed with LPDs between January 2000 and March 2017 at eight hospitals in Japan. The Kaplan-Meier method was used to analyze survival and the Cox proportional hazard model was applied to identify predictive factors.

RESULTS

Among all patients, 1-, 2- and 5-year overall survival rates were 89.5%, 86.1%, and 78.2%, respectively. Multivariable analysis revealed four 5-year survival risk factors assessed at diagnosis: age above 70 years (p = .002), deep lymphadenopathy and/or more than one extranodal lesion (p = .008), Eastern Cooperative Oncology Group/Zubrod performance status of 2-4 (p = .004), and classic Hodgkin lymphoma (CHL) histology (p = .047). Among 143 patients who achieved SR, 2- and 5-year relapse rates were 14.2% and 24.9%, respectively. CHL histology (p = .003) and serum soluble interleukin-2 receptor levels exceeding 2000 IU/L (p = .014) were associated with post-SR relapse-free survival. Blood lymphocyte counts were significantly lower at relapse than at 3-6 months prior (p < .001).

CONCLUSION

Assessment of the above risk factors and routine inspection of blood lymphocyte counts could aid in the care management of LPDs in RA.

摘要

目的

明确影响类风湿关节炎（RA）患者淋巴增殖性疾病（LPD）自发消退（SR）后 5 年生存率和复发率的因素。

方法

本回顾性纵向研究纳入了 2000 年 1 月至 2017 年 3 月期间在日本 8 家医院诊断为 LPD 的 232 例 RA 患者。采用 Kaplan-Meier 法分析生存情况，采用 Cox 比例风险模型识别预测因素。

结果

所有患者的 1、2 和 5 年总生存率分别为 89.5%、86.1%和 78.2%。多变量分析显示，诊断时评估的 4 个 5 年生存风险因素包括：年龄大于 70 岁（p=0.002）、深淋巴结病和/或多个结外病变（p=0.008）、东部肿瘤协作组/祖布罗德体能状态 2-4 级（p=0.004）和经典霍奇金淋巴瘤（CHL）组织学（p=0.047）。在 143 例达到 SR 的患者中，2 年和 5 年的复发率分别为 14.2%和 24.9%。CHL 组织学（p=0.003）和血清可溶性白细胞介素-2 受体水平超过 2000IU/L（p=0.014）与 SR 后无复发生存相关。复发时的血液淋巴细胞计数明显低于 3-6 个月前（p<0.001）。