Background and purpose: Diffuse large B cell lymphoma (DLBCL) can be divided into prognostically different subtypes according to gene expression profile. The aim of the present study was to analyze the clinical features, immunological subtypes and prognosis of nodular DLBCL, and investigate the more effective therapeutic method. Methods: Seventy cases of nodular DLBCL from Jiangxi Provincial Cancer Hospital during 2003 to 2009 were retrospectively reviewed. Clinical data and IPI scores were analyzed and the immunohistochemistry method was used. The patients were divided into GCB and non-GCB subgroups. The treatments included R-CHOP regimen and CHOP regimen. Kaplan-Meier analysis, log-rank test and Cox regression model were used in univariate and multivariate analysis and survival analysis of the clinical data, immunological subtypes and treatment results. Results: For all patients, the 5-year overall survival (OS) rate was 67.8%. The 5-year OS was higher in R-CHOP group than that in CHOP group (77.2% vs 58.9%, /N).O17). Although the 5-year OS had no statistical difference between the GCB group and the non-GCB group (73% vs 55.9%, P=0.3). Further analysis indicated that the 5-year OS was much lower in non-GCB subgroup than that in GCB subgroup in the CHOP regimen group (43.5% vs 66.8%, P=0.042). For the R-CHOP regimen group, the 5-year OS had no statistically significant difference between the non-GCB subgroupand the GCB subgroup (67.5% vs 80.4%, P=0.7l7). In non-GCB group, the 5-year OS was significantly higher in R-CHOP regimen sub-group than that in CHOP regimen sub-group (73.3% vs 42.9%, P=0.02). The R-CHOP regimen would significantly improve the long-term survival of non-GCB subtype patients. Univariate analysis indicated that age≥60, clinical stage ≥ Ⅲ, elevated serum LDH, B symptoms, IPI score ≥3 were associated with poor prognosis (P0.05). Multivariate Cox analysis indicated that only IPI score ≥3 was an independent poor prognostic factor with statistical significance (P<0.01). Conclusion: IPI score can predict the prognosis and survival of nodular DLBCL. Subdividing DLBCLs into different immunological subgroups according to immunohistochemistry can be helpful to clinical treatment options. The R-CHOP immunochemotherapy regimen would significantly improve the long-term survival of nodular DLBCL patients.%背景与目的:弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)根据基因表达可以分成有两种不同预后的亚型:生发中心B细胞样亚型(germinal centre B-cell lymphoma,GCB)和活化B细胞样亚型(non-germinal centre B-cell lymphoma,non-GCB).本文分析原发于淋巴结内DLBCL的临床特征、免疫亚型及预后,并探讨有效的治疗方法.方法:收集本院2003年-2009年诊治的70例结内DLBCL.分析其临床资料和IPI评分,用免疫组织化学染色分成GCB和non-GCB两类免疫亚型.治疗方法包括CHOP化疗及利妥昔单抗联合CHOP (R-CHOP)免疫化疗.用Kaplan-Meier法、log-rank检验和Cox回归模型对其临床资料、免疫亚型和治疗结果进行生存分析及单因素和多因素预后分析.结果:全组患者的5年生存期(overall survival,OS)为67.8％.其中CHOP化疗患者的5年OS为58.9％,R-CHOP免疫化疗患者为77.2％,免疫化疗明显优于单纯化疗(P=O.017).免疫亚型为GCB型患者5年OS为73％,non-GCB型患者为55.9％,两者差异无统计学意义(P=0.13).但进一步分析:用CHOP化疗的non-GCB型患者5年OS明显低于GCB型患者(43.5％ vs 66.8％,P=0.042)；而用R-CHOP免疫化疗的non-GCB型患者5年OS与GCB型患者差异无统计学意义(67.5％ vs 80.4％,P=0.717).在nonGCB亚型中,R-CHOP免疫化疗5年OS明显优于CHOP化疗(73.3％ vs 42.9％,P=0.02),提示R-CHOP免疫化疗能明显延长non-GCB亚型患者的长期生存.各临床因素与OS的关系:单因素分析表明年龄≥60岁、Ⅲ期、血清LDH升高、B症状和IPI≥3分均是预后不良的因素(P＜0.05).Cox多因素回归模型分析结果显示,IPI评分对OS的影响有统计学意义(P＜0.01),是独立的预后因素.结论:IPI可以预测结内DLBCL的预后和生存.采用免疫组化对DLBCL免疫分型对指导治疗有一定意义.R-CHOP免疫化疗能够显著提高结内DLBCL患者的长期生存率.
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