[Comparison the efficacy and prognosis of different first-line treatment for elderly diffuse large B-cell lymphoma].

Objective: To investigate the clinical features, survival and prognostic factors of elder patients with diffuse large B-cell lymphoma (DLBCL). Methods: The clinical data of elder patients with diffuse large B-cell lymphoma enrolled in the Cancer Hospital of Chinese Academy of Medical Sciences from April 2006 to December 2012 were retrospectively collected. All the patients were divided into R-CHOP-like group and CHOP-like group according to the dosage regimen. And the differences in demographic characteristics, clinical features, survival time and prognostic factors were compared between these two groups. Results: A total of 158 patients were enrolled, of which 78 patients in the R-CHOP-like group and 80 patients in the CHOP-like group were eligible. There were no significant differences between two groups on age, gender, pathological staging, B symptoms, bulky mass, ECOG score, IPI score, pathological type, LDH level, β(2)-MG level, lymphocyte/monocyte ratio(LMR), neutrophils/lymphocyte ratio(NLR), platelet/lymphocyte ratio(PLR), Ki-67 index and bone marrow invasion. In the R-CHOP like group, the median progression-free survival (PFS) time was 10 months, and the median overall survival (OS) time was 30 months. The 1-year and 2-year PFS rates were 46.2% and 19.2%, respectively. The 1-, 2-, and 5-year OS rates were 79.5%, 59.0%, and 19.2%, respectively. In the CHOP-like group, the median PFS was 7 months, and the median OS was 15 months. The 1-year and 2-year PFS rates were 27.5% and 12.5% respectively. The 1-year, 2-year, and 5-year OS rates were 65.0%, 32.5% and 13.8%, respectively. The median PFS time and OS time in the R-CHOP group were significantly better than those in the CHOP group (P<0.05 for both). A stratified analysis showed that the PFS time and OS time were superior in the R-CHOP-like group compared to the CHOP-like group among patients older than 70 years (P<0.05 for both). In patients with stage Ⅲ-Ⅳ, the PFS time and OS time in the R-CHOP-like group were also superior to CHOP-like group (P<0.05 for both). Univariate Cox regression analysis showed that IPI score, LDH value, β(2)-MG value, ECOG score, LMR, and PLR had an significant effect on prognosis (P<0.05 for all). Multivariate Cox regression analysis showed that lymphocyte/monocyte ratio and platelet/lymphocyte ratio were independent prognostic factors for diffuse large B-cell lymphoma (P<0.05 for both). Conclusions: The R-CHOP-like chemotherapy regimen is superior to the CHOP-like regimen in the first-line treatment of patients with diffuse large B-cell lymphoma. ECOG score, LMR and PLR may be independent prognostic factors for diffuse large B-cell lymphoma. ECOG score, LMR and PLR are independent prognostic factors.目的： 探讨老年弥漫大B细胞淋巴瘤(DLBCL)患者的临床特征、生存情况和预后影响因素。 方法： 回顾性分析中国医学科学院肿瘤医院2006年4月至2012年12月间收治的老年DLBCL患者的临床资料，按给药方案分为R－CHOP样组或CHOP样组，分析比较不同治疗方案组患者的临床特征、生存情况及预后影响因素。 结果： 共纳入158例患者，R－CHOP样组78例，CHOP样组80例。R－CHOP样组和CHOP样组患者的年龄、性别、疾病分期、B症状、大肿块、美国东部肿瘤协作组(ECOG)评分、国际预后指数(IPI)评分、病理类型、乳酸脱氢酶(LDH)水平、β(2)微球蛋白(β(2)－MG)水平、淋巴细胞单核细胞比(LMR)、嗜中性粒细胞淋巴细胞比(NLR)、血小板淋巴细胞比(PLR)、Ki－67指数、骨髓受侵等临床特征的差异均无统计学意义(均P>0.05)。R－CHOP样组患者的中位无进展生存时间(PFS)为10个月，中位总生存时间(OS)为30个月，1年、2年无进展生存率分别为46.2%和19.2%，1年、2年、5年总生存率分别为79.5%、59.0%和19.2%。CHOP样组患者的中位PFS为7个月，中位OS为15个月，1年、2年无进展生存率分别为27.5%和12.5%，1年、2年、5年总生存率分别为65.0%、32.5%和13.8%。R－CHOP样组患者的中位PFS和中位OS均明显优于CHOP样组(均P<0.05)。在>70岁患者中，R－CHOP样组患者的中位PFS和中位OS均优于CHOP样组(均P<0.05)；在Ⅲ～Ⅳ期患者中，R－CHOP样组患者的中位PFS和中位OS均优于CHOP样组(均P<0.05)。单因素Cox回归分析显示，IPI评分、LDH水平、β(2)－MG水平、ECOG评分、LMR和PLR与DLBCL患者的预后有关(P<0.05)。多因素Cox回归分析显示，ECOG评分、LMR和PLR是老年DLBCL的独立预后影响因素(P<0.05)。 结论： R－CHOP样化疗方案一线治疗老年DLBCL患者的疗效优于CHOP样方案，ECOG评分、LMR和PLR为老年DLBCL患者的独立预后影响因素。.