目的 分析老年套细胞淋巴瘤(mantle cell lymphoma,MCL)的临床病理特征及其影响预后因素,探讨其合理治疗模式。方法 回顾性分析2005-01至2015-07北京大学国际医院肿瘤内科和北京老年医院肿瘤内科收治的43例老年MCL患者,主要指标如年龄、分期、PS状态、国际预后指数评分等和治疗效果、生存情况。进行生存和预后因素分析。结果 全组患者中位年龄73岁(60～84岁);男女之比为3.3∶1,43例均接受联合化疗。中位随访时间38个月,全组患者的5年总生存率为17.3%,2年无病生存率为27.2%,3年无病生存率为0。中位无进展生存期20个月。单因素分析显示,MCL预后的影响因素包括治疗前PS状态、LDH、B症状、骨髓侵犯、外周血侵犯。而Cox回归多因素分析结果显示,只有PS状态和骨髓侵犯对预后的影响有统计学意义。结论 老年MCL具有临床分期晚、治疗效果欠佳及预后差等特点。PS状态和骨髓侵犯是预后的独立危险因素。目前初治患者多采用以CHOP或R-CHOP为主的方案化疗,不能治愈,需探索新的治疗方法。
Abstract
Objective To study the clinical features as well as therapeutic outcomes of elderly patients with mantle cell lymphoma (MCL) , identify the major prognostic factors and to explore the optimal approach.Methods We retrospectively analyzed 45 patients diagnosed with MCL in two hospitals between 2000 and 2007. Clinical data, including age,stage,performance status,international prognostic index,treatment modalities and clinical outcomes, were evaluated.Results The median age of the patients was 73 years (aged 60 to 84). The ratio of males to females was 3.3∶1. All the patients received combined chemotherapy. With a median follow-up of 38 months, the rates of 5-year overall and 2-year disease-free survivals were 17.3% and 27.2%, respectively. None remained disease-free at year 3. Median progression free survival was 20 months. There was no significant difference between the patients who had received CHOP regimen or R-CHOP regimen. Univariate analysis showed that PS, serum LDH levels, existence of B symptoms, bone marrow and peripheral blood involvement were the prognostic factors of overall survival for MCL patients. Cox regression multivariable analysis showed that only PS and bone marrow involvement were of statistic significance for prognosis.Conclusions Elderly patients with MCL are usually characterized by late staging, poor curative effect, and short survival.PS and bone marrow involvement are independent risk factors which affect the prognosis of elderly patients with MCL.MCL cannot be cured by standard CHOP or R-CHOP regimen. Newly diagnosed patients should be treated with novel modalities in order to improve the outcomes.
关键词
老年患者 /
套细胞淋巴瘤 /
临床特点 /
治疗 /
预后
Key words
elderly patients /
mantle cell lymphoma /
clinical features /
treatment /
prognosis
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