{"title":"[利妥昔单抗时代的原发性结节外弥漫大 B 细胞淋巴瘤：一项单中心回顾性分析】。］","authors":"Lan Yang, Li-Xia Cao, Hui-Juan Ren, Yan-Qiu Han","doi":"10.19746/j.cnki.issn.1009-2137.2024.04.023","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To investigate the clinical features and prognostic factors of patients with primary extranodal diffuse large B-cell lymphoma (DLBCL) in the rituximab era.</p><p><strong>Methods: </strong>The continuous data of newly diagnosed DLBCL patients with complete case data and first-line treated with rituximab, cyclophosphamide, epirubicin, vincristine, prednisone (R-CHOP) or R-CHOP treatment admitted to the Affiliated Hospital of Inner Mongolia Medical University from January 2013 to November 2023 were retrospectively analyzed. The clinical and molecular immunological features and prognosis of extranodal DLBCL were analyzed, Logistics regression model was used to analyzed the influencing factors of patients prognosis.</p><p><strong>Results: </strong>A total of 237 patients were enrolled, of which 54.4% (129 cases) were primary extranodal sources of DLBCL, and the most common extranodal sites were as follows: stomach (19.4%), colon (14.7%), tonsils (12.4%), skin/muscle (9.3%), central (7.7%), nasal/nasopharynx (6.2%), bone marrow (5.4%), testes (4.7%). The 3-year PFS and OS of DLBCL patients with extranodal involvement of bone marrow, central, liver, gastrointestinal or pulmonary origin were significantly lower than those of other patients with extranodal DLBCL of non-special site origin, and the difference was statistically significant (PFS: 65.2% <i>vs</i> 76.7%, <i>P</i> =0.008; OS: 82.6% <i>vs</i> 88.3%, <i>P</i> =0.04). Multivariate analysis showed that the prognostic factors affecting OS included NCCN-IPI score >3 (<i>OR</i> : 0.142, 95%<i>CI</i> : 0.041-0.495, <i>P</i> =0.002), non-germinal center source (<i>OR</i> : 2.675，95%<i>CI</i> :1.069-6.694，<i>P</i> =0.036), and DEL patients (<i>OR</i> : 0.327, 95%<i>CI</i> : 0.129-0.830, <i>P</i> =0.019). An NCCN-IPI score >3 was the only independent adverse prognostic factor for PFS (<i>OR</i> : 0.235, 95%<i>CI</i> : 0.116-0.474, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Patients with primary extranodal source DLBCL are more common in gastrointestinal involvement, and the overall prognosis is worse than that of patients with lymph node origin. NCCN-IPI score is an important independent adverse prognostic factor for predicting overall survival and progression-free survival in patients with primary extranodal diffuse large B-cell lymphoma.</p>","PeriodicalId":35777,"journal":{"name":"中国实验血液学杂志","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"[Primary Extranodal Diffuse Large B-Cell Lymphoma in the Rituximab Era: a Single-Center Retrospective Analysis].\",\"authors\":\"Lan Yang, Li-Xia Cao, Hui-Juan Ren, Yan-Qiu Han\",\"doi\":\"10.19746/j.cnki.issn.1009-2137.2024.04.023\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To investigate the clinical features and prognostic factors of patients with primary extranodal diffuse large B-cell lymphoma (DLBCL) in the rituximab era.</p><p><strong>Methods: </strong>The continuous data of newly diagnosed DLBCL patients with complete case data and first-line treated with rituximab, cyclophosphamide, epirubicin, vincristine, prednisone (R-CHOP) or R-CHOP treatment admitted to the Affiliated Hospital of Inner Mongolia Medical University from January 2013 to November 2023 were retrospectively analyzed. The clinical and molecular immunological features and prognosis of extranodal DLBCL were analyzed, Logistics regression model was used to analyzed the influencing factors of patients prognosis.</p><p><strong>Results: </strong>A total of 237 patients were enrolled, of which 54.4% (129 cases) were primary extranodal sources of DLBCL, and the most common extranodal sites were as follows: stomach (19.4%), colon (14.7%), tonsils (12.4%), skin/muscle (9.3%), central (7.7%), nasal/nasopharynx (6.2%), bone marrow (5.4%), testes (4.7%). The 3-year PFS and OS of DLBCL patients with extranodal involvement of bone marrow, central, liver, gastrointestinal or pulmonary origin were significantly lower than those of other patients with extranodal DLBCL of non-special site origin, and the difference was statistically significant (PFS: 65.2% <i>vs</i> 76.7%, <i>P</i> =0.008; OS: 82.6% <i>vs</i> 88.3%, <i>P</i> =0.04). Multivariate analysis showed that the prognostic factors affecting OS included NCCN-IPI score >3 (<i>OR</i> : 0.142, 95%<i>CI</i> : 0.041-0.495, <i>P</i> =0.002), non-germinal center source (<i>OR</i> : 2.675，95%<i>CI</i> :1.069-6.694，<i>P</i> =0.036), and DEL patients (<i>OR</i> : 0.327, 95%<i>CI</i> : 0.129-0.830, <i>P</i> =0.019). An NCCN-IPI score >3 was the only independent adverse prognostic factor for PFS (<i>OR</i> : 0.235, 95%<i>CI</i> : 0.116-0.474, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Patients with primary extranodal source DLBCL are more common in gastrointestinal involvement, and the overall prognosis is worse than that of patients with lymph node origin. NCCN-IPI score is an important independent adverse prognostic factor for predicting overall survival and progression-free survival in patients with primary extranodal diffuse large B-cell lymphoma.</p>\",\"PeriodicalId\":35777,\"journal\":{\"name\":\"中国实验血液学杂志\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"中国实验血液学杂志\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.19746/j.cnki.issn.1009-2137.2024.04.023\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"中国实验血液学杂志","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.19746/j.cnki.issn.1009-2137.2024.04.023","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目的研究利妥昔单抗时代原发性结节外弥漫大B细胞淋巴瘤（DLBCL）患者的临床特征和预后因素：方法：回顾性分析内蒙古医科大学附属医院2013年1月至2023年11月收治的新诊断DLBCL患者的连续资料，这些患者病例资料完整，一线接受利妥昔单抗、环磷酰胺、表柔比星、长春新碱、泼尼松（R-CHOP）或R-CHOP治疗。分析结节外DLBCL的临床和分子免疫学特征及预后，采用物流回归模型分析患者预后的影响因素：入组患者共237例，其中54.4%（129例）为原发性结外来源DLBCL，最常见的结外部位如下：胃（19.4%）、结肠（14.7%）、扁桃体（12.4%）、皮肤/肌肉（9.3%）、中央（7.7%）、鼻/鼻咽（6.2%）、骨髓（5.4%）、睾丸（4.7%）。骨髓、中央、肝脏、胃肠道或肺部来源的结节外受累DLBCL患者的3年PFS和OS明显低于其他非特殊部位来源的结节外DLBCL患者，差异有统计学意义（PFS：65.2% vs 76.7%，P =0.008；OS：82.6% vs 88.3%，P =0.04）。多变量分析显示，影响OS的预后因素包括NCCN-IPI评分>3（OR：0.142，95%CI：0.041-0.495，P =0.002）、非基因中心来源（OR：2.675，95%CI：1.069-6.694，P =0.036）和DEL患者（OR：0.327，95%CI：0.129-0.830，P =0.019）。NCCN-IPI评分>3是PFS唯一独立的不良预后因素（OR：0.235，95%CI：0.116-0.474，P<0.001）：结论：原发性结外来源DLBCL患者胃肠道受累更常见，总体预后比淋巴结来源患者更差。NCCN-IPI评分是预测原发性结节外来源弥漫大B细胞淋巴瘤患者总生存期和无进展生存期的重要独立不良预后因素。
[Primary Extranodal Diffuse Large B-Cell Lymphoma in the Rituximab Era: a Single-Center Retrospective Analysis].
Objective: To investigate the clinical features and prognostic factors of patients with primary extranodal diffuse large B-cell lymphoma (DLBCL) in the rituximab era.
Methods: The continuous data of newly diagnosed DLBCL patients with complete case data and first-line treated with rituximab, cyclophosphamide, epirubicin, vincristine, prednisone (R-CHOP) or R-CHOP treatment admitted to the Affiliated Hospital of Inner Mongolia Medical University from January 2013 to November 2023 were retrospectively analyzed. The clinical and molecular immunological features and prognosis of extranodal DLBCL were analyzed, Logistics regression model was used to analyzed the influencing factors of patients prognosis.
Results: A total of 237 patients were enrolled, of which 54.4% (129 cases) were primary extranodal sources of DLBCL, and the most common extranodal sites were as follows: stomach (19.4%), colon (14.7%), tonsils (12.4%), skin/muscle (9.3%), central (7.7%), nasal/nasopharynx (6.2%), bone marrow (5.4%), testes (4.7%). The 3-year PFS and OS of DLBCL patients with extranodal involvement of bone marrow, central, liver, gastrointestinal or pulmonary origin were significantly lower than those of other patients with extranodal DLBCL of non-special site origin, and the difference was statistically significant (PFS: 65.2% vs 76.7%, P =0.008; OS: 82.6% vs 88.3%, P =0.04). Multivariate analysis showed that the prognostic factors affecting OS included NCCN-IPI score >3 (OR : 0.142, 95%CI : 0.041-0.495, P =0.002), non-germinal center source (OR : 2.675，95%CI :1.069-6.694，P =0.036), and DEL patients (OR : 0.327, 95%CI : 0.129-0.830, P =0.019). An NCCN-IPI score >3 was the only independent adverse prognostic factor for PFS (OR : 0.235, 95%CI : 0.116-0.474, P < 0.001).
Conclusion: Patients with primary extranodal source DLBCL are more common in gastrointestinal involvement, and the overall prognosis is worse than that of patients with lymph node origin. NCCN-IPI score is an important independent adverse prognostic factor for predicting overall survival and progression-free survival in patients with primary extranodal diffuse large B-cell lymphoma.
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