目的 开展原发胃弥漫大B细胞淋巴瘤(PG-DLBCL)的临床及病理特征的回顾性队列研究,探究影响其疗效及预后的临床因素,特别是炎症及营养指标.方法 纳入2010年1月至2021年1月于空军军医大学西京医院诊疗的PG-DLBCL患者,分析其病理和临床特征对无进展生存时间(PFS)和总生存时间(OS)的影响.采用Kaplan-Meier生存曲线进行单因素生存分析,以及Cox比例风险模型进行多因素生存分析.结果 本研究共纳入84例PG-DLBCL患者,其中位PFS为39.5个月,5年PFS率为59.6%;中位OS为48个月,10年OS率为70.1%.单因素生存分析显现出PG-DLBCL病患的PFS预后影响因素包括病理分型、大体类型、淋巴结外病灶数目、Ann Arbor分期、Lugano分期、体力活动状态(PS)评分、淋巴瘤的国际预后(IPI)评分、血清乳酸脱氢酶(LDH)、β2微球蛋白(β2-MG)、衍生中性粒细胞/淋巴细胞比值(dNLR)、系统炎症反应指数(SIRI)、β2微球蛋白/淋巴细胞比值(βLR)、乳酸脱氢酶/淋巴细胞比值(LLR)及预后营养指数(PNI);OS的预后因素包括大体类型、淋巴结外病灶的数目、Lugano分期、Ann Arbor分期、PS评分、IPI评分、LDH、淋巴细胞/单核细胞比值(LMR)、SIRI、βLR、LLR、PNI及营养控制状态(CONUT)评分.多因素生存分析提示患者PFS的独立危险因素包括Lugano分期、PS评分、IPI评分、β2-MG升高及SIRI,OS的独立危险因素包括Lugano分期、PS评分、IPI评分及SIRI.结论 Lugano分期能更好地预测PG-DLBCL病患的预后;治疗应以化疗为主;dNLR、LMR、SIRI、PNI、βLR、LLR及CONUT评分为PG-DLBCL患者的简便且有意义的炎症及营养预后指标,其中SIRI对预后的预测价值更高,可能是一种新型预后指标.
Objective To conduct a retrospective cohort study on the clinical and pathological features of primary gastric diffuse large B-cell lymphoma(PG-DLBCL)to probe into the clinical factors which affect the efficacy and prognosis,especially inflammatory and nutritional indicators.Methods PG-DLBCL patients treated in Xijing Hospital,Air Force Medical University from January 2010 to January 2021 were included,and the effects of pathological and clinical features on progression-free survival time(PFS)and overall survival(OS)were analyzed.Kaplan-Meier survival curve was used for univariate survival analysis,and Cox proportional hazard model was used for multivariate survival analysis.Results A total of 84 PG-DLBCL patients were included in this study,whose median PFS was 39.5 months,5-year PFS rate was 59.6%,median OS was 48 months,and 10-year OS rate was 70.1%.Univariate survival analysis showed that the prognostic factors of PFS in PG-DLBCL patients included pathological classification,gross type,number of extra-lymph node lesions,Ann Arbor staging,Lugano staging,performance status(PS)score,international prognostic index(IPI)score,serum lactate dehydrogenase(LDH),β2-microglobulin(β2-MG),derived neutrophil/lymphocyte ratio(dNLR),systemic inflammatory response index(SIRI),β2 microglobulin/lymphocyte ratio(βLR),lactate dehydrogenase/lymphocyte ratio(LLR),and prognostic nutritional index(PNI).The prognostic factors of OS included gross type,number of extra-lymph node lesions,Lugano staging,Ann Arbor staging,PS score,IPI score,LDH,lymphocyte/monocyte ratio(LMR),SIRI,βLR,LLR,PNI and controlling nutritional status(CONUT)score.Multivariate survival analysis showed that the independent risk factors of PFS included Lugano staging,PS score,IPI score,elevated β2-MG and SIRI,while the independent risk factors of OS included Lugano stage,PS score,IPI score and SIRI.Conclusion Lugano staging can better predict the prognosis of PG-DLBCL patients,and chemotherapy should be the main treatment.dNLR,LMR,SIRI,PNI,βLR,LLR and CONUT score are simple and meaningful prognostic indicators of inflammation and nutrition in PG-DLBCL patients,among which SIRI has higher predictive value and may be a new prognostic indicator.