老年综合评估积分在高龄弥漫大B细胞淋巴瘤患者中的临床意义

摘要

目的 探讨高龄弥漫大B细胞淋巴瘤(DLBCL)患者的临床特点以及评价现有简明老年综合评估(CGA)积分在这些患者中的预测价值. 方法 本研究入选患者为2010年3月至2017年7月在北京医院诊断原发DLBCL,且年龄≥80岁的患者(24例).简明CGA积分包括3部分,年龄、日常活动能力评估以及共患病评估.按照积分分为不适合和衰弱组. 结果 10和14例患者划分为不适合和衰弱组.22例患者接受化疗,不良反应的发生比例在两组中相似.9例患者获得完全缓解(CR),5例患者获得部分缓解(PR),总反应率(ORR)为63.6％.不适合组患者达到CR的比例有高于衰弱组趋势(60.0％对25.0％;x2 =2.764,P=0.192),但ORR在两组中相似.不适合组和衰弱组分别有2和3例患者死于治疗相关并发症(20.0％对25.0％,x2=0.078;P=1.000),分别有3和5例患者死于复发/进展(30.0％对41.7％,x2=0.321,P=0.675).不适合组和衰弱组2年总生存和无进展生存分别为56.3％和35.2％(x2=0.635,P=0.426)以及42.2％和16.7％(x 2=2.156,P=0.142). 结论高龄DLBCL患者预后差,简明CGA积分系统在一定程度上能预测这些患者的预后.还需要继续完善现有的CGA积分来进一步预测这些患者的预后并进一步指导治疗.%Objective To investigate the clinical characteristics of diffuse large B-cell lymphoma (DLBCL) and to evaluated the predictive value of comprehensive geriatric assessment (CGA)in advanced-aged DLBCL patients.Methods A total of 24 patients aged 80 years and over diagnosed with DLBCL in our hospital from March 2010 to July 2017 were enrolled in this study.CGA included three parts:age,activities of daily living(ADL)/instrumental activities of daily living(IADL)and comorbidity evaluated by the cumulative illness rating score for geriatrics(CIRS-G).According to CGA scores,all patients were classified into either the not-applicable group or the frail group.Results There were 10 and 14 patients in the not-applicable group and the frail group,respectively.Twenty-two patients received chemotherapy,and the incidences of toxicity after chemotherapy were comparable between the two groups.Nine patients achieved complete remission (CR),five patients partial remission(PR),and the overall response rate(ORR) was 63.6 ％.The not-applicable group seemed to have a higher complete remission rate than the frail group(60.0 ％ vs.25.0 ％,x2=2.764,P =0.192).However,the overall response rates were comparable between the two groups.Treatment-related deaths occurred in 2 and 3 patients(20.0 ％ vs.25.0 ％,x2 =0.078,P =1.000)in the not-applicable and frail groups,respectively.Relapse/progression-related deaths occurred in 3 and 5 patients in the not-applicable and frail groups(30.0％ vs.41.7％,x2 =0.321,P =0.675),respectively.The 2-year overall survival rates and progression-free survival rates were 56.3 ％ versus 35.2 ％ (x2 =0.635,P =0.426)and 42.2 ％ versus 16.7 ％ (x2 =2.156,P =0.142) in the not-applicable and frail groups,respectively.Conclusions Advanced-aged patients with DLBCL have a poor prognosis,which can be predicted by CGA to a certain extent.Further improvement in the current CGA scoring system is still needed to accurately predict the prognosis of DLBCL in advanced-aged patients and to guide treatment.