Clinical Pathological Features And Analysis Of 179 Caseswith Diffuse Large B Cell Lymphoma(DLBCL)

Objective Summarizing the distribution of the diffuse large B-cell lymphoma(diffuse large B cell lymphoma,DLBCL) were admitted in General Hospital Of Ningxia Medical University in recent 10 years through case retrospective studies. Investigating DLBCL’s general clinical features, laboratory parameters, and pathological features, the overall treatment and the relationship between the curative effect of the first treatment and prognosis. In order to offer theoretical reference of standardizing the clinical individual therapy and predicting the prognosis of DLBCL,so as to lay the foundation of promoting the standardization of diagnosis and treatment of DLBCL in the region.Methods Collecting 179 cases from January 1,2004 to December 31,2013 in Ningxia Medical University General Hospital who have diagnosed with DLBCL by histopathology after sugaring or a biopsy.First of all,understanding the DLBCL patients’ general clinical features, laboratory parameters, and pathological features, the overall treatment and the distribution of the curative effect of the first treatment. Secondly, using the Kaplan-Meier method to analyze the DLBCL patients’ general clinical features(including age,gender,ethnicity,family history of cancer patients with DLBCL, Hepatitis B virus infection, the first symptom,starting position,the numbers of areas which beyond the scope of the lymph nodes,B symptoms,IPI(International Prognostic Index) score, performance status(Eastern Cooperative Oncology Group, ECOG)score, the number of extranodal sites of involvement,clinical stage,liver infiltration situation,spleen infiltration situation and bone marrow infiltration situation),laboratory parameters(anemia,lactate dehydrogenase(LDH),lymphocyte count(ALC) and serum albumin(ALB)),pathological features(histological type, tumor cell-derived,tumor size,CD5,Bcl-2 and cell proliferation index(Ki-67)), treatment-related indicators(treated or not,different treatment options,different chemotherapy regimens standardized treatment or not) and how much the curative effect of the first time treatment(complete response rates) effect on DLBCL patients’ Median Survival Time. Finally, multivariate analysis of prognostic single factors which may affect DLBCL through COX survival of DLBCL models.Results 1.The general situation:in 179 patients with DLBCL, male is slightly more than female(male:female=1.42:1);The median age is 59-year-old, less than 60 years old account for 53.1%(95/179);Han Chinese are more than Hui people(Han people accounted for 83.8%(150/179),Hui people accounted for 14.5%(26/179) and other nationalities accounted for 1.7%(3/179));With family history of cancer accounted for 8.4%(15/179);With 146 cases in 179 cases of patients,Hepatitis B virus(HBV) infection accounted for 15.1%(22/146).Clinical manifestations: 82 patients are primary within lymph nodes(45.8%), and surface lymph node enlargement as starting symptoms is accounted for 40.8%(73/179);Up to 97 patients are primary in outside of the lymph node(54.2%),the largest in the gastrointestinal tract(39.2%). There are 155 cases(54.2%) affected less than one outside the lymph node areas.There are symptoms of B group accounted for 33.5%(60/179).In IPI prognosis groups, low-risk group accounted for 20.7%(37/179),low-medium risk group accounted for 30.7%(55/179),medium-high-risk group accounts for 22.3%(40/179),high-risk group accounts for 26.3%(47/179).ECOG score 0-1 points accounted for 80.4%(144/179).Clinical stageⅠ-Ⅱaccounted for 52.5%(94/179). Liver and spleen infiltration all in 21 cases(11.7%),bone marrow infiltration in 16 cases(11.1%) of 144 patients who underwent bone marrow cytology.Taking the large lump cut-off point as 7.5cm,<7.5cm significantly more than 7.5cm or more(151/179),84.4%(28/179) VS15.6 %).Taking 10.0 cm as diagnostic criteria of big lump, ≥ 10.0cm were 22 cases(12.3%).Laboratory indicators: increased LDH accounted for 35.2%(63/179). Newly diagnosed with anemia is 56 cases(31.3%). ALC<1.0*109/L are 35 cases(19.6%).57 cases(31.8%) have hypoalbuminemia. Pathological characteristics: in 179 cases of DLBCL patients,56 cases of pathology is not clear, in 123 cases of known pathology,117 cases is DLBCL-NOS, 5 cases is DLBCL- subtypes, one case is other large B-cell lymphoma(specifically for primary mediastinal DLBCL). In 179 cases of newly diagnosed patients with DLBCL,there were 108 cases who have already judgded tumor cells, more common in non-GCB(75/108,69.4%).35 patients examined the CD5 expression,positive expression of which is 15 cases(42.9%).57 patients examined the expression of Bcl-2,positive expression of which accounted for 66.7%(38/57).152 patients teasted the Ki-67, the main express≥50%(128 / 152,84.2%). Treatment: In 179 cases of DLBCL patients, 33 cases give up treatment, in 146 treated cases,2 cases received radiotherapy;101 cases received chemotherapy,43 cases received radiotherapy combined chemotherapy.In the 144 cases who used chemotherapy, 44 cases with RCHOP as first-line program, select the CHOP program because of economic reasons accounted for 61.0%(61/100),not been rituximab patients accounted for 22.0%(22/100)because of hepatitis B virus replication, physicians do not select rituximab in 12 cases and 5cases allergy to rituximab and overload of tumor.Based on 2012 ESMO and 2013 China diffuse large B-cell lymphoma diagnosis and treatment guidelines,in 146 cases of patients, standard treatment is 17 cases, non-standardized treatmen is 129 cases, and according to 2014 NCCN guidelines standardized treatment is 31 cases,115 cases of non-standardized treatment. In 146 cases of DLBCL patients after initial treatment and assessing the treatment efficacy evaluation,reaching clinical CR were 113 cases,33 cases are non-complete remission( which PR 6cases, SD 19 cases, PD 8cases),complete remission rate was 77.4%.2.In 179 patients with DLBCL,5-year median survival was 41.41 months. Kaplan-Meier method by single factor analysis showed:age, number of extranodal involvement,group B symptoms,IPI score,ECOG score,clinical stage,tumor size(10.0cm as a dividing point),accompanied by anemia at first diagnosis,ALC decreased, hypoproteinemia,LDH increased,histological type,tumor-derived cells,CD5 expression, Ki-67 ≥ 50%, whether the treatment, different treatment options, different chemotherapy regimens and standardized treatment are associated with the prognosis of DLBCL.3. Multivariate analysis those single factors who may affect DLBCL by COX survival model showed:Age,family history of cancer,group B symptoms,IPI score,clinical stage,big lumps,ALC,Bcl-2 positive expression,Ki-67 proliferation index,different chemotherapy regimens, whether standard treatment and whether the first treatment to achieve complete remission,DLBCL patients’ 5-year survival is low,which is an independent prognostic factor in patients with DLBCL.Conclusion 1.The whole set of data, the median age of DLBCL patients is 59 years old and male is slightly more than female.Clinically often find the surface lymph nodes as the first symptom.Starting extranodal sites is more often than within the lymph nodes,especially in the gastrointestinal tract is the most common.The number of organs with extranodal involvement often≤1. About 1/3 patients with B symptom.IPI score with the highest proportion is low-medium risk.Clinical stage is more on stage Ⅰ- Ⅱ.15% with a large lump.About 1/3 patients have anemia,hypoproteinemia and elevated LDH at first diagnosis.Very few patients’ ACL levels below normal at first diagnosis. In pathologic type,DLBCL-unspecified type is maximum,non-GCB is more than GCB. The vast majority of patients with Ki-67 proliferation index ≥50%, Bcl-2 positive expression rateis high, CD5 positive expression is less than negative.2.Older than 60 years, the number of extranodal involvement>1, B group of symptoms,higher IPI score ECOG score, the later clinical stage,tumor diameter≥10.0cm,LDH levels higher than normal,newly diagnosed with anemia and hypoalbuminemia, DLBCL-subtypes, non-GCB, CD5 high expression,Ki-67 high proliferation index,no treating patieents,only receive radiotherapy or chemotherapy,first-line chemotherapy program is CHOP program, not be standardized treatment and initial treatment did not achieve complete remission.All those patients have poor prognosis of DLBCL. Among them, the age, family history of cancer, group B symptoms, IPI grade, clinical stage, big lumps, ALC, Bcl-2 positive expression,Ki-67 proliferation index,different chemotherapy regimens,whether standard treatment and whether the first treatment to achieve complete remission is independent risk factors for judging the prognosis of patients with DLBCL.3.The standardized treatment situation in this hospital is grim, should be solved.