Zeng C G, Wei Z Q, Huang J T, Zhu J, Sun F F, Wang J, Lu S Y, Zhang Y Z, Sun X F, Zhen Z Z
Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
Zhonghua Xue Ye Xue Za Zhi. 2024 Dec 14;45(12):1098-1105. doi: 10.3760/cma.j.cn121090-20240624-00234.
This study aimed to investigate the effect of tumor lysis syndrome (TLS) on the prognosis of children and adolescents with intermediate- or high-risk high-grade mature B-cell nonHodgkin lymphoma (HG B-NHL) . This study collected the clinical data and prognosis of 283 patients aged <18 years with newly diagnosed intermediate- or high-risk HG B-NHL treated at the Sun Yat-sen University Cancer Center from January 2010 to December 2022. The clinical characteristics, laboratory indicators during TLS, and prognosis of the patients were analyzed. The optimal cutoff values of laboratory indicators during TLS were identified using R studio according to event-free survival (EFS) . Of the 283 patients enrolled, the median age was 7 (range: 1-18) years and the male-to-female ratio was 3.6∶1, 76 (26.9%) developed TLS, and 207 (73.1%) did not. Patients with TLS demonstrated higher proportions of the pathological subtype Burkitt lymphoma, high-risk stratification, age <12 years, and LDH of ≥1 000 IU/L compared with patients without TLS (all <0.05). The 5-year EFS and overall survival (OS) rates of the entire group were (84.5±2.2) % and (88.2±2.0) %, respectively. The 5-year OS rate of patients with TLS was significantly lower than that of those without TLS [ (80.8±4.6) % (91.0±2.0) %, =0.01]. Among patients with TLS, those with serum uric acid of ≤612.7 μmol/L (=36) exhibited lower 5-year EFS [ (67.8±8.1) % (87.5±5.2) %, =0.04] and OS rates [ (69.9±8.1) % (90.0±4.7) %, =0.04] compared with those with uric acid of >612.7 μmol/L (=40). Similarly, patients with serum phosphate of ≤1.89 mmol/L (=58) demonstrated lower 5-year EFS [ (71.6±6.0) % 100%, =0.02] and OS rates [ (74.8±5.8) % 100%, =0.03] compared with those with phosphate of >1.89 mmol/L (=18) . TLS is associated with poor prognosis in patients with HG B-NHL. Patients with lower serum uric acid and phosphate levels during TLS demonstrated worse prognoses, indicating their potential value in predicting prognosis and guiding stratified treatment.
本研究旨在探讨肿瘤溶解综合征（TLS）对中高危高级别成熟B细胞非霍奇金淋巴瘤（HG B-NHL）儿童及青少年预后的影响。本研究收集了2010年1月至2022年12月在中山大学肿瘤防治中心接受治疗的283例年龄＜18岁新诊断的中高危HG B-NHL患者的临床资料及预后情况。分析了患者的临床特征、TLS期间的实验室指标及预后。使用R studio根据无事件生存期（EFS）确定TLS期间实验室指标的最佳截断值。在纳入的283例患者中，中位年龄为7岁（范围：1-18岁），男女比例为3.6∶1；76例（26.9%）发生TLS，207例（73.1%）未发生。与未发生TLS的患者相比，发生TLS的患者中伯基特淋巴瘤病理亚型、高危分层、年龄＜12岁及乳酸脱氢酶≥1 000 IU/L的比例更高（均P＜0.05）。全组患者的5年EFS率和总生存率（OS）分别为（84.5±2.2）%和（88.2±2.0）%。发生TLS患者的5年OS率显著低于未发生TLS的患者[（80.8±4.6）%对（91.0±2.0）%，P =0.01]。在发生TLS的患者中，血清尿酸≤612.7 μmol/L的患者（n =36）与尿酸＞612.7 μmol/L的患者（n =40）相比，5年EFS率[（67.8±8.1）%对（87.5±5.2）%，P =0.04]和OS率[（69.9±8.1）%对（90.0±4.7）%，P =0.04]更低。同样，血清磷酸盐≤1.89 mmol/L的患者（n =58）与磷酸盐＞1.89 mmol/L的患者（n =18）相比，5年EFS率[（71.6±6.0）%对100%，P =0.02]和OS率[（74.8±5.8）%对100%，P =0.03]更低。TLS与HG B-NHL患者的不良预后相关。TLS期间血清尿酸和磷酸盐水平较低的患者预后较差，提示其在预测预后及指导分层治疗方面的潜在价值。
