Value of plasma fibrinogen level before treatment in prognosis of patients with diffuse large B-cell lymphoma
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摘要: 目的 探讨治疗前血浆纤维蛋白原(Fib)水平在初治弥漫大B细胞淋巴瘤(DLBCL)患者预后判断中的价值。方法 回顾性分析符合入选标准的389例初治DLBCL患者治疗前血浆Fib水平与患者临床病理特征及预后的关系。采用受试者工作特征曲线确定治疗前血浆Fib截断值，按截断值将患者分为Fib高水平组(245例)和Fib低水平组(144例)。比较2组患者临床病理特征、总生存期(OS)及疾病无进展生存期(PFS)的差异，单因素和多因素回归分别分析初治DLBCL患者临床病理特征与预后的关系。结果 治疗前血浆Fib高水平组DLBCL患者中，血清乳酸脱氢酶(LDH)水平高于正常上限、Ann Arbor分期Ⅲ~Ⅳ、B症状、更高的国际预后指数(IPI)和NCCN-IPI评分的患者比例显著高于Fib低水平组。LDH水平高于正常、ECOG评分2~4分、Ann Arbor分期Ⅲ~Ⅳ、结外侵犯部位>1处、Fib高水平的初治DLBCL患者的OS、PFS较其他患者更短。多因素分析显示，LDH水平高于正常、ECOG评分2~4分是初治DLBCL患者OS的独立不良预后因子，LDH水平高于正常、结外侵犯部位>1处是初治DLBCL患者PFS的独立不良预后因子，治疗前血浆Fib高水平不是初治DLBCL患者OS、PFS的独立不良预后因子。结论 治疗前血浆Fib高水平与初治DLBCL患者不良预后相关，但并不是独立不良预后因子。Abstract: Objective To explore the prognostic value of plasma fibrinogen(Fib) level before treatment in patients with newly diagnosed diffuse large B-cell lymphoma(DLBCL).Methods The association of plasma Fib level before treatment and clinicopathological characteristics and prognosis of 389 patients with newly diagnosed DLBCL who met inclusion criteria was analyzed retrospectively. The cut-off value of plasma Fib level before treatment was determined by a receiver operator characteristic curve. Patients were divided into high level group(245 cases) and low level group(144 cases) according to the cut-off value. The differences in clinicopathological characteristics, overall survival(OS) and disease progression-free survival(PFS) between the two groups were compared. The relationship of clinicopathological characteristics and prognosis in patients with newly diagnosed DLBCL was analyzed by univariate and multivariate regression analysis.Results The proportion of patients with serum lactate dehydrogenase(LDH)>upper limit of normal, Ann Arbor stage Ⅲ-Ⅳ, B symptoms, higher international prognostic index(IPI) score and NCCN-IPI score was significantly higher in high plasma Fib group than those in low level group. Newly diagnosed DLBCL patients with LDH>upper limit of normal, or ECOG score 2-4, or Ann Arbor stage Ⅲ-Ⅳ, or more than 1 site of extranodal diseases, or high plasma Fib level had shorter OS and PFS than others. Multivariate analysis showed that LDH>upper limit of normal and ECOG score 2-4 were independent poor prognostic factors for OS of patients with newly diagnosed DLBCL. LDH>upper limit of normal and more than 1 site of extranodal diseases were independent poor prognostic factors for PFS of patients with newly diagnosed DLBCL. High plasma Fib level before treatment was not an independent poor prognostic factor for OS and PFS of patients with newly diagnosed DLBCL.Conclusion High plasma Fib level before treatment is associated with poor prognosis for patients with newly diagnosed DLBCL, but not an independent poor prognostic factor.
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Key words:
- diffuse large B-cell lymphoma /
- fibrinogen /
- prognosis
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表 1 治疗前血浆Fib水平与患者临床特征的关系
例 特征 Fib水平 P Fib低水平组
(144例)Fib高水平组
(245例)年龄 0.66 >60岁 48 88 ≤60岁 96 157 性别 1.00 男 87 147 女 57 98 LDH水平 < 0.01 >正常上限 52 139 正常 92 106 ECOG评分 0.26 0~1分 116 185 2~4分 28 60 Ann Arbor分期 0.04 Ⅰ~Ⅱ期 63 81 Ⅲ~Ⅳ期 81 164 结外病灶 0.27 ＞1 43 88 ≤1 101 157 B症状 0.02 无 117 172 有 27 73 IPI评分 0.02 低危(0~1分) 69 82 低中危(2分) 33 55 高中危(3分) 26 62 高危(4~5分) 16 46 NCCN-IPI评分 0.01 低危(0~1分) 38 41 低中危(2~3分) 67 101 高中危(4~5分) 26 79 高危(≥6分) 13 24 细胞亚型 0.49 生发中心 52 94 非生发中心 83 142 不能分类 9 9 
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表 2 影响DLBCL患者OS的单因素和多因素分析
特征 单因素分析 多因素分析 风险比(95%CI) P 风险比(95%CI) P 年龄(>60岁vs ≤60岁) 0.60(0.35~1.03) 0.06 性别(男vs女) 1.21(0.71~2.06) 0.49 B症状(有vs无) 2.60(1.53~4.43) < 0.01 LDH水平(>正常上限vs正常) 4.68(2.41~9.06) < 0.01 3.72(1.87~7.40) < 0.01 ECOG评分(2~4 vs 0~1) 3.26(1.92~5.55) < 0.01 2.20(1.26~3.82) < 0.01 Ann Arbor分期(Ⅲ~Ⅳ vs Ⅰ~Ⅱ) 2.83(1.43~5.63) < 0.01 结外病灶(＞1 vs ≤1) 2.15(1.27~3.66) < 0.01 细胞亚型(生发中心vs非生发中心) 1.67(0.90~3.09) 0.11 Fib水平(高vs低) 2.22(1.17~4.21) 0.02
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表 3 影响DLBCL患者PFS的单因素和多因素分析
特征 单因素分析 多因素分析 风险比(95%CI) P 风险比(95%CI) P 年龄(>60岁vs ≤60岁) 1.37(0.89~2.10) 0.16 性别(男vs女) 1.08(0.71~1.65) 0.71 B症状(有vs无) 1.51(0.97~2.36) 0.07 LDH水平(>正常上限vs正常) 2.52(1.61~3.92) < 0.01 2.17(1.37~3.44) < 0.01 ECOG评分(2~4 vs 0~1) 2.24(1.45~3.45) < 0.01 Ann Arbor分期(Ⅲ~Ⅳ vs Ⅰ~Ⅱ) 2.49(1.49~4.19) < 0.01 结外病灶(＞1 vs ≤1) 2.14(1.41~3.25) < 0.01 1.73(1.12~2.66) 0.01 细胞亚型(生发中心vs非生发中心) 1.50(0.95~2.39) 0.09 Fib水平(高vs低) 1.69(1.06~2.70) 0.03
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