[艾滋病相关弥漫大 B 细胞淋巴瘤的临床特征和预后因素]。

Q3 Medicine

中华预防医学杂志 Pub Date : 2024-10-06 DOI:10.3760/cma.j.cn112150-20240422-00332

W Luo, Q H Ma, L Y He, H C Wang, F L Wu, J W Hu, Y Wu, T Tao

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引用次数: 0

摘要

目的探讨艾滋病相关弥漫大B细胞淋巴瘤（AIDS-DLBCL）患者的一般临床特征和治疗效果，为AIDS-DLBCL患者的诊断治疗、生存预后、预防和管理提供理论依据。本研究选取2017年1月至2020年1月在长沙市第一医院接受联合抗逆转录病毒治疗（cART）的AIDS-DLBCL患者为研究对象。采用Kaplan-Meier法绘制生存曲线，并采用Cox比例危险回归模型分析AIDS-DLBCL特定变量与无进展生存期和总生存期之间的关系。根据患者的临床特征进行了相关性分析。研究共纳入了50名AIDS-DLBCL患者。他们的中位年龄（Q1，Q3）为52（44，59）岁，其中46人（92%）为男性。约20名患者（40%）接受了环磷酰胺、多柔比星、长春新碱和泼尼松（CHOP）治疗，23名患者（46%）接受了利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松（RCHOP）治疗。生存曲线分析显示，AIDS-DLBCL 患者的两年无进展生存率和总生存率分别为 56.9% 和 61.6%。RCHOP方案联合EBV-DNA≥1 000拷贝/毫升的患者的无进展生存率（χ2=3.844，P=0.043）和总生存率（χ2=4.662，P=0.031）高于CHOP方案联合EBV-DNA≥1 000拷贝/毫升的患者。多变量分析表明，男性（HR=2.70，95%CI:1.10-6.80）、EB病毒载量≥1 000拷贝/毫升（HR=1.75，95%CI:1.12-2.84）、HIV-RNA≥200拷贝/毫升（HR=4.64，95%CI: 1.73-12.15）、ECOG PS评分≥1 000拷贝/毫升（HR=1.75，95%CI:1.12-2.84）、HIV-RNA≥200拷贝/毫升（HR=4.64，95%CI:1.73-12.15）、ECOG PS 评分 2 至 4 分（HR=3.54，95%CI:1.62-7.33）和国际预后指数（IPI）评分 3 至 5 分（HR=5.21，95%CI:1.39-20.14）的患者疾病进展风险较高。EB病毒载量≥1000拷贝/毫升（HR=0.07，95%CI:0.05-0.93）的患者接受RCHOP方案治疗后，疾病进展的风险较小。男性（HR=2.87，95%CI:1.65-9.17）、EB病毒载量≥1 000拷贝/毫升（HR=1.61，95%CI:4.02-9.36）、HIV-RNA≥200拷贝/毫升（HR=1.19，95%CI:1.58-2.74）、ECOG PS 评分 2 至 4 分（HR=6.42，95%CI:2.55-14.33）、IPI 评分 3 至 5 分（HR=2.78，95%CI:1.41-12.96）的患者有较高的死亡风险。EB病毒载量≥1 000拷贝/毫升（HR=0.24，95%CI:0.64-0.90）的患者采用RCHOP方案的死亡风险较低。综上所述，男性、ECOG体力状态评分2至4分、IPI评分3至5分、EB病毒载量≥1 000拷贝/毫升和HIV病毒载量≥200拷贝/毫升是影响艾滋病-DLBCL患者无进展生存期和总生存期的危险因素。RCHOP方案联合EB病毒载量≥1000拷贝/毫升是影响艾滋病-DLBCL患者无进展生存期和总生存期的保护因素。

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[Clinical features and prognostic factors of AIDS-associated diffuse large B-cell lymphoma].

To explore the general clinical features and treatment outcomes of patients with AIDS-related diffuse large B-cell lymphoma (AIDS-DLBCL) and provide a theoretical basis for diagnosis and treatment, survival prognosis, prevention and management of AIDS-DLBCL patients. AIDS-DLBCL patients who received combined antiretroviral therapy (cART) at Changsha First Hospital from January 2017 to January 2020 were selected in this study. The survival curves were plotted using the Kaplan-Meier method, and the Cox proportional hazards regression model was used to analyze the association between AIDS-DLBCL specific variables and progression-free survival and overall survival. Correlation analysis was conducted based on the clinical features of the patients. A total of 50 AIDS-DLBCL patients were included. Their median age (Q₁, Q₃) was 52 (44, 59) years, of whom 46 (92%) were male. About 20 (40%) patients received treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), while 23 patients (46%) received treatment with rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP). Survival curve analysis showed that the 2-year progression-free survival rate and overall survival rate of AIDS-DLBCL patients were 56.9% and 61.6%, respectively. Patients with RCHOP protocol combined with EBV-DNA≥1 000 copies/ml had higher progression-free survival rate (χ²=3.844, P=0.043) and overall survival rate (χ²=4.662, P=0.031) than those with CHOP protocol combined with EBV-DNA≥1 000 copies/ml. A multivariate analysis showed that male (HR=2.70, 95%CI:1.10-6.80), EB viral load≥1 000 copies/ml (HR=1.75, 95%CI:1.12-2.84), HIV-RNA≥200 copies/ml (HR=4.64, 95%CI: 1.73-12.15), ECOG PS score of 2 to 4 points (HR=3.54, 95%CI:1.62-7.33), and international prognostic index (IPI) score of 3 to 5 points (HR=5.21, 95%CI:1.39-20.14) were at a higher risk of disease progression. Patients with EB viral load≥1 000 copies/ml (HR=0.07, 95%CI:0.05-0.93) on the RCHOP regimen had a small risk of disease progression. Males (HR=2.87, 95%CI:1.65-9.17), EB viral load≥1 000 copies/ml (HR=1.61, 95%CI:4.02-9.36), HIV-RNA≥200 copies/ml (HR=1.19, 95%CI:1.58-2.74), ECOG PS score of 2 to 4 (HR=6.42, 95%CI:2.55-14.33), IPI score of 3 to 5 points (HR=2.78, 95%CI:1.41-12.96) had a high risk of mortality. Patients with EB viral load≥1 000 copies/ml (HR=0.24, 95%CI:0.64-0.90) on the RCHOP regimen had a low risk of mortality. In summary, males, ECOG physical status score of 2 to 4 points, IPI score of 3 to 5 points, EB viral load≥1 000 copies/ml and HIV viral load≥200 copies/ml are risk factors affecting progression-free survival and overall survival of AIDS-DLBCL patients. RCHOP regimen combined with EB viral load≥1 000 copies/ml is a protective factor affecting progression-free survival and overall survival in AIDS-DLBCL patients.

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来源期刊

中华预防医学杂志 Medicine-Medicine (all)

CiteScore

1.20

自引率

0.00%

发文量

12678

期刊介绍： Chinese Journal of Preventive Medicine (CJPM), the successor to Chinese Health Journal , was initiated on October 1, 1953. In 1960, it was amalgamated with the Chinese Medical Journal and the Journal of Medical History and Health Care , and thereafter, was renamed as People’s Care . On November 25, 1978, the publication was denominated as Chinese Journal of Preventive Medicine . The contents of CJPM deal with a wide range of disciplines and technologies including epidemiology, environmental health, nutrition and food hygiene, occupational health, hygiene for children and adolescents, radiological health, toxicology, biostatistics, social medicine, pathogenic and epidemiological research in malignant tumor, surveillance and immunization.