摘要
背景与目的：在利妥昔单抗时代,滤泡性淋巴瘤（follicular lymphoma,FL）国际预后指数（follicular lymphoma international prognostic index,FLIPI）等传统预后参数在FL中的预后作用存在局限性。该研究旨在探讨外周血淋巴细胞与单核细胞绝对计数比值（absolute lymphocyte count/absolute monocyte count,ALC/AMC）在中国人群FL中的意义。方法：对2003年1月—2013年12月以利妥昔单抗联合环磷酰胺、多柔比星、长春新碱及泼尼松（R-CHOP）样化疗方案治疗136例初治FL患者的情况进行回顾性分析,收集所有患者的外周血ALC/AMC数据,并进行FLIPI评分。结果：根据FLIPI评分,低危（评分0～1分）61例（44.9%）,中危（评分2分）42例（30.9%）,高危（评分3～5分）33例（24.2%）;FLIPI低危、中危和高危组的治疗有效率分别为88.5%、95.2%和78.8%（P=0.090）,2年无进展生存率（progression-free suivival,PFS）分别为91.4%、74.6%和47.8%（log-rank=23.3,P〈0.001）;ALC/AMC≥4.7及〈4.7患者的有效率分别为91.9%和68.6%（P=0.005）,2年PFS分别为96.0%和69.7%（log-rank=13.0,P〈0.001）。多因素分析显示,ALC/AMC≥4.7是独立于FLIPI的预后因素。对FLIPI无法区分的低危及中危患者,可通过ALC/AMC进一步细分为预后不同的两组（log-rank=7.535,P=0.006）。结论：对使用R-CHOP样方案的FL患者,ALC/AMC是简单可行的预后指标,反映患者机体免疫及肿瘤微环境并具有独立于FLIPI的预后意义。对于FLIPI难以区分的低危及中危患者,应当考虑ALC/AMC作为综合判断患者长期生存的预后指标。
Background and purpose： The prognostic capability of traditional prognostic index like follicular lymphoma international prognostic index （FLIPI） is limited in the rituximab era. This study was to investigate the prognostic significance of peripheral blood absolute lymphocyte count/absolute monocyte count （ALC/AMC） in Chinese patients with follicular lymphoma （FL）. Methods： This study retrospectively analyzed 136 newly diagnosed FL patients who received rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone （R-CHOP）-like chemotherapy in Department of Hematology, Ruijin Hospital from Jan. 2003 to Dec. 2013, and further classified these patients according to FLIPI scoring system. Results： According to FLIPI, 61 patients （44.9%） were stratified into the low-risk （0-1 points） group, 42 cases （30.9%） into the intermediate-risk （2 points） group, and 33 cases （24.2%） into the high-risk （3-5 points） group. The overall response rate and 2-year progression-free survival （PFS） of the 3 risk groups were 88.5%, 95.2%, and 78.8% （P=0.090）, and 91.4%, 74.6%, and 47.8% （log-rank=23.3,P〈0.001）, respectively. The overall response rate and 2-year PFS for patients with ALC/AMC≥4.7 and 〈4.7 were 91.9%, 68.6% （P=0.005） and 96.0%, 69.7% （log-rank=13.0, P〈0.001）, respectively. In the multivariate study, ALC/AMC≥4.7 was independent of FLIPI and was able to distinguish the FLIPI low-risk and intermediate-risk patients （log-rank=7.535, P=0.006）. Conclusion： For FL patients treated with R-CHOPlike regimens, ALC/AMC is a simple and effective biomarker reflecting tumor microenvironment and human immunity, and could be considered for prognosis evaluation.
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2016年第10期861-865,共5页
China Oncology
基金
国家自然科学基金委员会青年科学基金(81201863)
上海市科学技术委员会科研计划(08411953900)
瑞金医院优秀青年教师(800000000003)
上海交通大学晨星青年学者奖励计划
上海市青年医师培养资助计划
