Research On Treatment And Prognostic Factors Of Advanced-stage Diffuse Large B-cell Lymphoma

Part 1.Retrospective analysis of the clinical features,treatment and prognostic factors of 370 patients with advanced-stage diffuse large B-cell lymphomaObjective We analyzed the disease’s clinical features and prognosis to guide better treatment for diffuse large B-cell lymphoma(DLBCL).Methods We retrospective collected data from advanced-stage DLBCL cases from January 2006 to December 2012 in one cancer center.We then analyzed the demographic characteristics,clinical stage,histological diagnosis,treatment and prognostic characteristics of such patients.Results A total of 370 patients with median age of 55 years old(range:12-91 years)were included in the study.The male-to-female ratio was 1.3.361 patients received therapy,treatment strategy include chemotherapy alone for 280 cases,chemoradiotherapy for 65 cases,and chemotherapy combined with ASHCT for 16 cases.Under a median follow-up of 89 months,the 5-year OS of the whole group was 42.9%.The patients in low risk group,low-intermediate risk group,high-intermediate risk group and high risk group achieved OS of 65.3%,56.5%,34.7%and 21.9%(P<0.001),respectively.For advanced-stage DLBCL patients treated with chemotherapy alone,chemoradiotherapy,and chemotherapy combined with ASHCT,the 5-year OS rates were 36.1%,58.3%,87.5%(p<0.001),respectively.Multivariate analysis demonstrated that age(p=0.037),Ann Arbor stage(p=0.030),B symptom(p<0.001),bulky disease(p=0.003),ECOG PS score(p=0.001),Ki-67 index(p=0.002),CD5 expression(p=0.027),LDH elevated(p=0.022),32-MG elevated(p=0.042)and chemotherapy combined with rituximab(p<0.001)were associated with prognosis in the advanced-stage DLBCL.Conclusion Chemotherapy combined with rituximab could improve outcome of advanced-stage DLBCL.Age,stage,B symptom,bulky disease,ECOG PS score,Ki-67 index,CD5 expression,LDH,32-MG and chemotherapy combined with rituximab were associated with poor prognosis.Part 2.The prognostic significance of inflammatory indicators for advanced-stage diffuse large B-cell lymphomaObjective To explore the prognostic significance of inflammatory indicator,neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR),for advanced-stage diffuse large B-cell lymphoma(DLBCL).Methods We retrospectively collected data from advanced stage DLBCL case seen from January 2006 to December 2012 in National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences.The patients were divided into the low NLR group("5:1)and the high NLR group(>5:1);the low PLR group(≤300:1)and the high PLR group(>300:1).Kaplan-Meier method was used to compare the survival rates between groups,multivriate Cox proportional hazard regression analysis was performed to assess the independent prognostic significance of clinical and histopathological variables on events or OS.Results A total of 361 patietns were included in the study.Under a median follow-up of 89 months,the 5-year overall survival(OS)and progression-free survival(PFS)of the whole group were 42.9%and 31.3%,respectively.The 5-year OS rate and PFS rate were 48.2%and 35.1%in the low NLR group,which were 24.1%and 17.7%in the high NLR group,respectively.The 5-year OS rates and PFS rate were 45.4%and 33.2%in the low PLR group,which were 29.8%and 21.1%in the high PLR group(allp<0.05).Univariate analysis showed that NLR>5:1,PLR>300:1,age>60 year,ECOG PS>1score,stage IV,B symptom,bulky disease,number of extranodal sites>1,Ki-67index>90%.LDH elevated and β2-MG elevated had significant influence on prognosis(all p<0.05).Multivariate analysis demonstrated that NLR,stage,B symptom,bulky disease,ECOG PS score,Ki-67 index and β2-MG were associated with poor prognosis in the advanced-stage DLBCL.Conclusion NLR was simple and feasible biomarker for prognosis of advanced-stage DLBCL patients.