| Objective: The diffuse large B-cell lymphoma(DLBCL) is the most common type of lymphoid cancer,which has multiple clinical behaviors, immunophenotypes,different responses to treatment and prognosis. Hence, it’s really necessary tofind some factors which are related with the prognosis of DLBCL.The aim of the study is to investigate the relationship of clinical features,lab findings,the origin of tumor cell as well as prognosis in Chinese patients with DLBCL.Methods:159patients with pathologically confirmed DLBCL were enrolledin the first Affiliated Hospital of Dalian Medical University from July2004toSeptember2011.The median overall survival (OS) and median progression free survival which were campared in these index,such as age, serum LDH,ECOG score,extranodal involvement,clinical stage, internation-al prognostic index(IPI),subgroups of immunohistochemistry,B symptom, primary site,bulky mass,serum haemoglobin(HB),lymphocyte count, Ki-67. And investigate the appearance of GCB andnon-GCB in different sub-group.Results: For159patients with DLBCL,median age is57years old,the youngest is15and the oldest is88.The disease is more common among female population and the male to female ratio is about1to1.12.The number of nodal originating cases and extranodal originating cases is55(34.6%),104(65.4%)respectively.The incidence rate of the throat-ring23(14.5%)is significantly higher than intestinal18(11.3%)and stomach21(13.2%).When dividing the cases into two groups according to their level of HB (normal level of HB group and anemia group),it turns that the number of GCB type is more than non-GCB type in normal level of HB,while non-GCB type is more seen than GCB type in anemia, the differences are statistically significant.GC B type is much more than non-GCB type in no B symptom group,while GCBtype is less than non-GCB type in B symptom group, and differences are statistically significant. GCB type is much more than non-GCB type in IPI0-2group,while GCB type is less than non-GCB type in IPI3-5group, the differences arestatistically significant.Anemia is common in patients with elevated LDH (30%vs16%,P=0.049).Anemia is also significantly associated with performance status superioror equal to2(36%versus13%,P=0.001). Thus, anemia is more common in patients who have classic adverse prognostic factors and high-risk IPI score. Although anemia is also associated with high clinical stage(27%versus18%), there are no statistically significant differences.Overall survival (OS)and progression free survival (PFS)for age≤60years group are inferior to age>60(P=0.023,0.068respectively). OS and PFS are statistically superior for normal level LDH group versus high level LDH group(OS:30vs14months respectively,P=0.049;PFS:22vs8months respectively，P=0.000).There is a significant better prognosis in OS and PFS with ECOG score0-1versusECOG score2-4(OS:27vs18months respectively,P=0.026;PFS:18.6vs10.5months respectively,P=0.006). Compared with non-GCB type there was a good OS and PFS for GCB(OS:36vs14months,PFS:24vs10.5months,P both <0.001).TheOS of IPI score0-1,2,3,4-5is26,21,17.5,11months respectively(P=0.023),the PFS is21.5,12,8,4moths respectively (P<0.001).OS and PFS for B symptom groupare inferior to no B symptom group (P=0.276,0.019respectively).The OS andPFS of clinical stage I-II are superior than clinical stage III-IV (OS:25.5vs18months respectively,P=0.251;PFS:20vs10months respectively,P=0.022). The OSof tumor diameter such as D<5cm,5cm≤D<10cm,D≥10cm is31.5,18,15.3months respectively,there are no statistically significant differences(P=0.108).But the PFS is20,12,8months respectively,the differences are statistically significant (P=0.026). Compared with the group of extranodal originating,lymphocyte count≤1,extranodal involvement≥2,anemia and Ki-67≥50%,the group of nodal originating, lymphocyte count>1,extranodal involvement<2, normal level of HB and Ki-67<50%have good OS and PFS,but there are no statistically significant differences.Multiple factor regression analysis displays: immunophenotype, LDH and ECOG are all significant influential factors,which effect the OS,(P=0.000,0.026,0.012,respectively). Immunophenotype,LDH and ECOG and clinical stage influence t he PFS,(P=0.000,0.010,0.010,0.037, respectively).In high level of LDH, the patient of non-GCB type have a worse prognosis.(OS,P=0.000；PFS, P=0.001).In ECOG2-4group, the patient of non-GCB type have a worse prognosis too.(OS,P=0.000;PFS, P=0.001).Conclusion:1.In IPI3-5,anaemia onset and B symptom with fever,athrepsy,skin itch,non-GCB type is more seen than GCB type.2.Anemia is significantly associated with a performance status superior or equal to2, elevated LDH and high-risk IPI scor.3.Survival analysis shows the immunophenotype,LDH, ECOG,IPI, age andstage are prognosis factors of DLBCL.Cox regression analysis displays that immunophenotype,LDH,ECOG and stage are independent prognostic factors.4.Compared with high level of LDH, non-GCB type, IPI0-2,ECOG2-4and advance stage, normal level of LDH,GCB type, IPI3-5,ECOG0-1and early stage have a good. In both high level of LDH and ECOG2-4, non-GCB type isbetter than GCB type for prognosis. |
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