207例原发性CD5阳性弥漫大B细胞淋巴瘤临床病理特征和预后分析：一项淮海淋巴瘤工作组多中心回顾性研究

沈子园; 闫冬梅; 李炳宗; 顾伟英; 王飞; 朱俊峰; 朱太岗; 贾韬; 苗雨青; 张颢; 于亮; 王春玲; 夏瑞祥; 刘沁华; 徐开林; 桑威; 张翠娟; 叶静静

doi:10.13201/j.issn.1004-2806.2022.09.010

207例原发性CD5阳性弥漫大B细胞淋巴瘤临床病理特征和预后分析：一项淮海淋巴瘤工作组多中心回顾性研究

- 1.
  安徽医科大学公共卫生学院流行病与卫生统计学系(合肥，230032)
- 2.
  徐州医科大学附属医院血液科
- 3.
  苏州大学附属第二医院血液科
- 4.
  常州市第一人民医院血液科
- 5.
  蚌埠医学院第一附属医院血液科
- 6.
  安徽皖北煤电集团总医院血液科
- 7.
  连云港市第一人民医院血液科
- 8.
  盐城市第一人民医院血液科
- 9.
  济宁医学院附属医院血液科
- 10.
  淮安市第一人民医院血液科
- 11.
  安徽医科大学附属第一医院血液科
- 12.
  山东大学齐鲁医院病理科
- 13.
  山东大学齐鲁医院血液科
基金项目:
国家自然科学基金项目(No：82170182)；江苏省青年医学重点人才(No：QNRC2016791)；江苏省自然科学基金(No：BK20171181)；江苏省科技厅社会发展重点项目(No：BE2019638)

详细信息

通讯作者: 叶静静，E-mail：yejingjing@sdu.edu.cn

中图分类号: R733.4

收稿日期: 2022-06-17

刊出日期: 2022-09-01

Clinicopathological features and prognosis of 207 patients with primary CD5-positive diffuse large B-cell lymphoma: a multicenter retrospective study of Huaihai Lymphoma Working Group

- 1.
  Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, China
- 2.
  Department of Hematology, Affiliated Hospital of Xuzhou Medical University
- 3.
  Department of Hematology, the Second Affiliated Hospital of Soochow University
- 4.
  Department of Hematology, the First People's Hospital of Changzhou
- 5.
  Department of Hematology, the First Affiliated Hospital of Bengbu Medical College
- 6.
  Department of Hematology, Wanbei Coal Power Group General Hospital
- 7.
  Department of Hematology, the First People's Hospital of Lianyungang
- 8.
  Department of Hematology, Yancheng First People's Hospital
- 9.
  Department of Hematology, the Affiliated Hospital of Jining Medical University
- 10.
  Department of Hematology, the First People's Hospital of Huaian
- 11.
  Department of Hematology, the First Affiliated Hospital of Anhui Medical University
- 12.
  Department of Pathology, Qilu Hospital of Shandong University
- 13.
  Department of Hematology, Qilu Hospital of Shandong University

More Information

Corresponding author: YE Jingjing, E-mail: yejingjing@sdu.edu.cn

Received Date: 17 June 2022

Publish Date: 01 September 2022

摘要

摘要: 目的探讨原发性CD5阳性弥漫大B细胞淋巴瘤(CD5⁺DLBCL)的临床病理特征和预后影响因素。方法收集2010年3月—2021年8月淮海淋巴瘤协作组中11家医疗中心确诊的207例CD5⁺DLBCL患者的临床资料。采用免疫组织化学方法分析患者的病理特征，基于Cox比例风险回归模型筛选CD5⁺DLBCL患者的预后影响因素。结果 207例患者中男102例，女105例，中位年龄61(24~90)岁，5年总体生存率为47.5%，Ann Arbor分期Ⅲ/Ⅳ期119例(57.5%)，44例(21.3%)出现中枢神经受累，MYC/BCL-2双表达95例(45.9%)。采用R-CHOP/R-CHOP-like治疗方案、强化疗治疗方案和CHOP/CHOP-like治疗方案的患者间生存时间比较，差异均无统计学意义；接受BTK抑制剂泽布替尼治疗方案的患者生存时间明显优于未使用BTK抑制剂的患者(P=0.038)。Kaplan-Meier分析结果表明，Ann Arbor分期、ECOG评分、IPI评分和细胞起源影响患者的生存(P< 0.05)。多因素分析结果提示，年龄、白蛋白和ECOG评分是预后的独立影响因素(P< 0.05)。结论 CD5⁺DLBCL患者具有独特的临床病理特征，年龄、白蛋白和ECOG评分是预后的独立影响因素。
- 原发性CD5阳性弥漫大B细胞淋巴瘤 /
- 临床病理特征 /
- 预后分析
Abstract: Objective To investigate the clinicopathological features and prognostic factors of primary CD5⁺diffuse large B-cell lymphoma(CD5⁺DLBCL).Methods Clinical data of 207 patients with CD5⁺DLBCL diagnosed in 11 medical centers in the Huaihai Lymphoma Working Group from March 2010 to August 2021 were collected. Immunohistochemical methods were used to analyze the pathological characteristics of patients, and Cox proportional risk regression model was used to screen the prognostic factors of CD5⁺DLBCL patients.Results The median age at diagnosis was 61(24-90) years old, with 102 males and 105 females. The overall 5-year survival rate was 47.5%. One hundred and nineteen cases(57.5%) were Ann Arbor stage Ⅲ/Ⅳ, 44 cases(21.3%) had central nervous system involvement, and 95 cases(45.9%) had MYC/BCL-2 double expression. There was no difference in survival among patients treated with R-CHOP/R-CHOP-like, intensive chemotherapy, or CHOP/CHOP-like, and patients treated with BTK inhibitor zanubrutinib had significantly better survival than those without BTK inhibitor(P=0.038). Kaplan-Meier analysis showed that Ann Arbor staging, ECOG score, IPI score and cell origin influenced survival(P< 0.05). Multivariate analysis indicated that age, albumin and ECOG score were independent prognostic factors(P< 0.05).Conclusion CD5⁺DLBCL patients have unique clinicopathological features, and age, albumin and ECOG score are independent prognostic factors.
- CD5⁺diffuse large B-cell lymphoma /
- clinicopathological features /
- prognostic analysis

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图 1 DLBCL患者的5年生存曲线

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图 2 DLBCL患者的病理特征

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图 3 不同治疗方案DLBCL患者的生存曲线

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图 4 不同临床特征对患者生存的影响

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图 5 基于MaxStat获取白蛋白的最佳截断值

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表 1 207例CD5⁺DLBCL患者的临床特征与免疫表型间的相关分析

临床特征		MYC/例		χ²	P	BCL-2/例		χ²	P	BCL-6/例		χ²	P
临床特征		-	+	χ²	P	-	+	χ²	P	-	+	χ²	P
性别	男	66	36	0.023	0.879	31	71	0.019	0.892	45	57	0.360	0.548
	女	69	36			31	74			42	63
B症状	无	103	45	4.386	0.036	41	107	1.252	0.263	56	92	3.744	0.053
	有	32	27			21	38			31	28
中枢受累	无	111	52	2.805	0.094	45	118	2.009	0.156	65	98	1.457	0.227
	有	24	20			17	27			22	22
骨髓受累	无	111	49	5.370	0.024	42	118	4.602	0.032	58	102	9.659	0.002
	有	24	23			20	27			29	18
Ann Arbor分期	Ⅰ/Ⅱ期	61	27	1.135	0.287	27	61	0.039	0.844	31	57	2.907	0.088
	Ⅲ/Ⅳ期	74	45			35	84			56	63
细胞起源	GCB	43	17	1.976	0.160	16	44	0.696	0.404	23	37	0.676	0.411
	Non-GCB	92	55			46	101			64	83

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表 2 存活组与死亡组患者间临床特征比较例(%)

临床特征	存活组(126例)	死亡组(81例)	χ²	P	临床特征	存活组(126例)	死亡组(81例)	χ²	P
Ann Arbor分期			9.036	0.003	BCL-2			0.053	0.818
Ⅰ/Ⅱ期	64(50.79)	24(29.63)			阴性	37(29.37)	25(30.86)
Ⅲ/Ⅳ期	62(49.21)	57(70.37)			阳性	89(70.63)	56(69.14)
ECOG评分			29.949	< 0.001	BCL-6			0.091	0.763
< 2	113(89.68)	24(29.63)			阴性	54(42.86)	33(40.74)
≥2	13(10.32)	57(70.37)			阳性	72(57.14)	48(59.26)
MYC			2.082	0.149	Ki-67			0.307	0.580
阴性	87(69.05)	48(59.26)			≤90%	123(97.62)	78(96.30)
阳性	39(30.95)	33(40.74)			> 90%	3(2.38)	3(3.70)

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表 3 207例CD5⁺DLBCL患者的预后影响因素分析

单因素分析			多因素分析
变量	HR	P	变量	HR	95%CI	P
年龄 > 74岁	4.313	< 0.001	年龄
红细胞计数 > 4.2×10⁹/L	0.354	< 0.001	≤74岁
白蛋白 > 42.8 g/L	0.269	< 0.001	> 74岁	6.791	2.514~18.341	< 0.001
血红蛋白 > 131.0 g/L	0.448	0.003	白蛋白
中性粒细胞计数 > 3.8×10⁹/L	2.081	0.003	≤42.8 g/L
乳酸脱氢酶 > 344.0 U/L	1.984	0.003	> 42.8 g/L	0.265	0.103~0.684	0.006
白细胞计数 > 5.8×10⁹/L	2.040	0.004	ECOG评分
Ann Arbor分期(Ⅲ/Ⅳ期)	2.132	0.002	< 2
ECOG评分 > 2	3.288	< 0.001	≥2	2.401	1.233~4.673	0.010
IPI评分(中高危组/高危组)	2.263	0.001	红细胞计数
B症状(有)	1.814	0.010	≤4.2×10⁹/L
中枢受累(有)	1.798	0.015	> 4.2×10⁹/L	0.252	0.063~1.010	0.052

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