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Title: [Evaluation of different staging systems and prognostic analysis of 110 primary gastrointestinal diffuse large B cell lymphoma].
Author: Mao L, Wang X, Wang CY, Xia B, Ning QY, Yang HL, Yu Y, Zhang YZ.
Journal: Zhonghua Yi Xue Za Zhi; 2019 Jun 25; 99(24):1853-1858. PubMed ID: 31269579.
Abstract:
Objective: To compare the prognostic efficiency of Lugano staging, TNM staging and Musshoff staging systems in patients with primary gastrointestinal diffuse large B-cell lymphoma(PGI-DLBCL) and investigate its clinical features and prognosis. Methods: The clinical data of 110 patients with PGI-DLBCL in Tianjin Medical University Cancer Institute and Hospital from May 2008 to August 2017 was retrospectively analyzed. The stage of lymphoma was assessed following Lugano staging, TNM staging and Musshoff staging systems respectively. The prognostic value was compared mainly according to the situation of 5-year overall survival (OS)and the influence of different clinical features on prognosis of patients was also investigated. Results: The median age of the whole study was 55(range 17-92) years old. With a median follow-up time of 36 (range 1-115) months, the median progression-free survival (PFS) was 35 (range 0-86) months, and the median overall survival was 37 (range 2-104) months. The 5-year OS rate of Lugano stagingⅠ, Ⅱ, Ⅲ and Ⅳ were 77.6%, 73.4%, 69.7%, 12.2% (χ(2)=63.395, P<0.001) respectively. The 5-year OS rate of TNM staging Ⅰ, Ⅱ, Ⅲ and Ⅳ were 77.6%, 75.9%, 25.0%, 9.3% (χ(2)=65.802, P<0.001) respectively. The 5-year OS rate of Musshoff stagingⅠ, Ⅱ, Ⅲ and Ⅳ were 84.5%, 68.4%, 25.0%, 9.3% (χ(2)=66.966, P<0.001) respectively. By Cox multiple-factors analysis, Lugano staging system was the only independent prognosis risk factor for PFS (HR=4.987, 95%CI: 1.421-17.498, P=0.009) and OS (HR=5.659, 95%CI: 1.563-20.485, P=0.008) of PGI-DLBCL. Univariated analysis revealed that the factors affecting PFS and OS of patients with PG-DLBCL include B-symptom, Eastern Cooperative Oncology Group performance status (ECOG PS), the number of extranodal lesions, serum lactate dehydrogenase (LDH), International prognostic index (IPI) score, staging and therapeutic regimen(all P values of PFS and OS<0.05). Patients with PG-DLBCL who received chemotherapy alone showed a better survival than others (PFS P=0.004; OS P<0.001); the factors affecting PFS and OS of patients with PI-DLBCL include β2-microglobulin(β2-MG), serum albumin(ALB) levels, LDH and staging (all P values of PFS and OS<0.05). Therapeutic regimen didn't affect those patients' survival (PFS P=0.661, OS P=0.720). The additional use of Rituximab failed to improve the survival of patients with PG-DLBCL and PI-DLBCL respectively (all P values of PFS and OS>0.05). Conclusions: Compared with TNM staging and Musshoff staging systems, Lugano staging system provides the best prognostic value in PFS and OS for patients with PGI-DLBCL. Accompany with B-sympto, higher ECOG PS score, more extranodal lesions, increased LDH, higher IPI score and later period are negative factors for PG-DLBCL. Increased β2-MG and LDH, lower ALB level and later period are negative factors of PI-DLBCL. 目的： 比较Lugano、TNM以及Musshoff分期系统在原发胃肠道弥漫大B细胞淋巴瘤（PGI-DLBCL）生存预测中的价值，并探讨其临床特征及预后。 方法： 回顾性分析2008年5月至2017年8月来自天津医科大学附属肿瘤医院的110例PGI-DLBCL患者的临床资料，对患者分别使用Lugano、TNM以及Musshoff分期系统进行分期，对比各分期系统5年总生存期（OS）差异，并研究不同临床因素对预后的影响。 结果： 110例PGI-DLBCL患者中位年龄为55（17~92）岁，中位随访时间为36（1~115）个月，中位无进展生存期（PFS）为35（0~86）个月，中位OS为37（2~104）个月。使用Lugano分期系统时，Ⅰ、Ⅱ、ⅡE期和Ⅳ期患者的5年总生存率分别为77.6%、73.4%、69.7%、12.2%（χ(2)=63.395，P<0.001）；使用TNM分期系统时，Ⅰ、Ⅱ、Ⅲ期和Ⅳ期患者的5年总生存率分别为77.6%、75.9%、25.0%、9.3%（χ(2)=65.802，P<0.001）；使用Musshoff分期系统时，Ⅰ、Ⅱ、Ⅲ期和Ⅳ期患者的5年总生存率分别为84.5%、68.4%、25.0%、9.3%（χ(2)=66.966，P<0.001）。Cox多因素分析结果显示仅Lugano分期是PGI-DLBCL患者PFS（HR=4.987，95%CI：1.421~17.498，P=0.009）和OS（HR=5.659，95%CI：1.563~20.485，P=0.008）的独立不良预后因素。单因素分析显示：B症状、美国东部肿瘤协作组体能状态（ECOG PS）评分、结外病变数目、血清乳酸脱氢酶（LDH）、国际预后指数评分（IPI）、分期和治疗方案是原发胃弥漫大B细胞淋巴瘤的预后影响因素（PFS、OS均P<0.05），采用单纯化疗的原发胃弥漫大B细胞淋巴瘤患者预后更好（PFS P=0.004，OS P<0.001）；β2微球蛋白（β2-MG）、LDH、白蛋白（ALB）和分期是原发肠道弥漫大B细胞淋巴瘤的预后影响因素（PFS、OS均P<0.05），治疗方案对其预后影响差异无统计学意义（PFS P=0.661，OS P=0.720）；使用利妥昔单抗的患者与未使用利妥昔单抗的患者生存差异无统计学意义（PFS、OS均P>0.05）。 结论： Lugano分期系统较TNM、Musshoff分期系统可更好预测PGI-DLBCL患者生存；伴随B症状、ECOG评分高、结外病变数目多、LDH升高、IPI评分高、分期晚为原发胃弥漫大B细胞淋巴瘤不良预后因素；β2微球蛋白升高、LDH升高、ALB降低和分期晚是原发肠道弥漫大B细胞淋巴瘤的不良预后因素。.

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