CHOPE与CHOPE—L方案治疗65例外周T细胞淋巴瘤非特异型效果及预后影响因素分析(1)
[摘要] 目的 评价应用CHOPE与CHOPE-L方案治疗外周T细胞淋巴瘤非特异型(PTCL-U)的效果及其预后影响因素。 方法 对2005年1月～2012年1月经中国医科大学附属盛京医院病理及免疫组化确诊的65例PTCL-U患者的资料进行回顾性分析，评价CHOPE与CHOPE-L方案的治疗效果及其预后影响因素。 结果 20例应用CHOPE方案治疗，完全缓解(CR)4例(20.0%)，部分缓解(PR)5例(25.0%)，总有效率(OR)为45.0%；1、2、3年的总生存率分别为75.0%、40.0%及15.0%。45例应用CHOPE-L方案治疗，CR 12例(26.7%)，PR 19例(42.2%)，OR为68.9%；1、2、3年的总生存率分别为82.2%、62.2%及40.0%。Ann Arbor分期Ⅰ～Ⅱ期、结外侵犯0～1个、无骨髓侵犯、Ki-67≤50%及应用CHOPE-L方案的患者较Ann Arbor分期Ⅲ～Ⅳ期、结外侵犯≥2个、有骨髓侵犯、Ki-67>50%及应用CHOPE方案的患者化疗有效率高，差异有统计学意义(P < 0.05)。一般状况评分(ECOG评分)0～1分、国际预后指数(IPI)评分≤2分、Ki-67≤50%及应用CHOPE-L方案化疗的患者较ECOG评分2～4分、IPI评分>2分、Ki-67>50%及应用CHOPE方案化疗的患者3年生存率高，差异有统计学意义(P < 0.05)。多因素分析显示，IPI评分是本组病例的独立预后因素(P < 0.05)。 结论 PTCL-U是一类预后不良的疾病，左旋门冬酰胺酶(L-ASP)的应用提高了化疗有效率及3年生存率，且安全性好，不良反应可耐受。Ann Arbor分期、结外侵犯、骨髓侵犯、Ki-67及化疗方案是影响近期疗效的重要因素。患者的ECOG评分、IPI评分、Ki-67及化疗方案是影响患者预后的重要因素。
[关键词] 外周T细胞淋巴瘤；CHOPE方案；左旋门冬酰胺酶；预后因素；治疗
[中图分类号] R734 [文献标识码] A [文章编号] 1673-7210(2015)06(b)-0055-05
Treatment response and prognostic factors in 65 patients with peripheral T cell lymphoma-unspecified treated by CHOPE and CHOPE-L chemotherapy
LI Jia LIU Zhuogang
Department of Hematology， Shengjing Hospital Affiliated to China Medical University， Liaoning Province， Shenyang 110022， China
[Abstract] Objective To investigate the treatment response and prognostic factors in patients with peripheral T cell lymphomas-unspecified (PTCL-U) treated by CHOPE and CHOPE-L chemotherapy. Methods The clinical data of 65 pathology and immunohistochemistry confirmed patients with PTCL-U in Shengjing Hospital Affiliated to China Medical University from January 2005 to January 2012 were retrospectively analyzed， in order to evaluate the treatment response and prognosic factors of CHOPE and CHOPE-L chemotherapy. Results Of 20 cases treated by CHOPE， complete remission (CR) rate was 20.0% (4/20)， partial remission (PR) rate was 25.0% (5/20) and overall response (OR) rate was 45.0%.The overall survival rates of 1， 2 and 3 years was 75.0%， 40.0% and 15.0% respectively. Of 45 cases treated by CHOPE-L， CR rate was 26.7% (12/45)， PR rate was 42.2% (19/45) and OR rate was 68.9%. The overall survival rates of 1， 2 and 3 years was 82.2%， 62.2% and 40.0% respectively. Ann Arbor stage Ⅰ-Ⅱ， extranodal involvement of 0-1， the patients without bone marrow involvement， Ki-67≤50% and the application of CHOPE-L chemotherapy had a better recent curative effect compared with Ann Arbor stage Ⅲ-Ⅳ， extranodal involvement of more than two， the patients with bone marrow involvement， Ki-67 > 50% and the application of CHOPE chemotherapy (P < 0.05). ECOG scoring 0-1， International prognostic index (IPI) ≤2， Ki-67≤50% and the application of CHOPE-L chemotherapy had a higher 3-year overall survival rate compared with ECOG scoring 2-4， IPI scoring >2， Ki-67 > 50% and the application of CHOPE chemotherapy (P < 0.05). Multi-factors analysis of IPI scoring was independent prognostic factors in this group of patients (P < 0.05). Conclusion PTCL-U is a kind of disease with poor prognosis. The use of L-asparaginase (L-ASP) improves the rate of response to chemotherapy and survival rate in 3 years. The security is good and the side effects can be tolerated. Ann Arbor stage， extranodal involvement， bone marrow involvement， Ki-67 and CHOPE-L chemotherapy are important factors affecting the recent curative effect. ECOG score， IPI score， Ki-67 and CHOPE-L chemotherapy are important prognostic factors. (李佳 刘卓刚)
[关键词] 外周T细胞淋巴瘤；CHOPE方案；左旋门冬酰胺酶；预后因素；治疗
[中图分类号] R734 [文献标识码] A [文章编号] 1673-7210(2015)06(b)-0055-05
Treatment response and prognostic factors in 65 patients with peripheral T cell lymphoma-unspecified treated by CHOPE and CHOPE-L chemotherapy
LI Jia LIU Zhuogang
Department of Hematology， Shengjing Hospital Affiliated to China Medical University， Liaoning Province， Shenyang 110022， China
[Abstract] Objective To investigate the treatment response and prognostic factors in patients with peripheral T cell lymphomas-unspecified (PTCL-U) treated by CHOPE and CHOPE-L chemotherapy. Methods The clinical data of 65 pathology and immunohistochemistry confirmed patients with PTCL-U in Shengjing Hospital Affiliated to China Medical University from January 2005 to January 2012 were retrospectively analyzed， in order to evaluate the treatment response and prognosic factors of CHOPE and CHOPE-L chemotherapy. Results Of 20 cases treated by CHOPE， complete remission (CR) rate was 20.0% (4/20)， partial remission (PR) rate was 25.0% (5/20) and overall response (OR) rate was 45.0%.The overall survival rates of 1， 2 and 3 years was 75.0%， 40.0% and 15.0% respectively. Of 45 cases treated by CHOPE-L， CR rate was 26.7% (12/45)， PR rate was 42.2% (19/45) and OR rate was 68.9%. The overall survival rates of 1， 2 and 3 years was 82.2%， 62.2% and 40.0% respectively. Ann Arbor stage Ⅰ-Ⅱ， extranodal involvement of 0-1， the patients without bone marrow involvement， Ki-67≤50% and the application of CHOPE-L chemotherapy had a better recent curative effect compared with Ann Arbor stage Ⅲ-Ⅳ， extranodal involvement of more than two， the patients with bone marrow involvement， Ki-67 > 50% and the application of CHOPE chemotherapy (P < 0.05). ECOG scoring 0-1， International prognostic index (IPI) ≤2， Ki-67≤50% and the application of CHOPE-L chemotherapy had a higher 3-year overall survival rate compared with ECOG scoring 2-4， IPI scoring >2， Ki-67 > 50% and the application of CHOPE chemotherapy (P < 0.05). Multi-factors analysis of IPI scoring was independent prognostic factors in this group of patients (P < 0.05). Conclusion PTCL-U is a kind of disease with poor prognosis. The use of L-asparaginase (L-ASP) improves the rate of response to chemotherapy and survival rate in 3 years. The security is good and the side effects can be tolerated. Ann Arbor stage， extranodal involvement， bone marrow involvement， Ki-67 and CHOPE-L chemotherapy are important factors affecting the recent curative effect. ECOG score， IPI score， Ki-67 and CHOPE-L chemotherapy are important prognostic factors. (李佳 刘卓刚)