Clinical Pathological Features Analysis Of Refractory/Relapsed Diffuse Large B Cell Lymphoma(DLBCL)

Objective To understand the overall status of patients with relapsed/refractory large B cell lymphoma(DLBCL)in recent 7 years in General Hospital Of Ningxia Medical University through case retrospective studies and compared them with those with non-relapsed/non-refractory DLBCL,to summarize the clinicopathological features of patients with relapsed/refractory DLBCL and explore the clinicopathological factors that can predict them in early stage,so as to take early and effective measures to improve the patients' prognosis.Methods Collecting 183 cases from January 1,2010 to December 31,2016 in General Hospital Of Ningxia Medical University who have diagnosed with DLBCL by histopathology after sugaring or a biopsy and excluding all patients who have not undergone standardized treatment,the final 159 cases of DLBCL patients as research subjects.According to the diagnostic criteria of relapse / refractory DLBCL,the patients were divided into relapsed/refractory DLBCL group and non-relapsed/non-refractory DLBCL group.First,statistical analysis was performed on whether or not R-CHOP regimens were used in the two groups of patients to determine if there were differences between the two groups;Secondly,reviewed the pathological of 56 patients with relapsed/refractory groups to understand its absence misdiagnosis;finally,compared the two groups in general clinical features,laboratory parameters,pathological features differences using the chi-square test and analysised clinical and pathological features of patients with relapsed / refractory DLBCL.Results1.There were 90 patients treated with R-CHOP regimen in this study.Amongthem,26 patients(46.4%,26/56)were in the relapsed/refractory group,and 64(62.1%)were in the non-relapsed/non-refractory group.The difference between the two groups was not statistically significant(P>0.05).2.In this study,all patients in the relapsed/refractory group were reviewed for pathology.Three patients' initial diagnosis were inconsistent after the review,one case was diagnosed as mantle cell lymphoma after reexamination,and 2 patients was FL merged DLBCL,3 patients with B cell-derived lymphoma.However,due to poorly fixed specimens and lack of some immunohistochemical markers,the specific type was not clear,and the initial diagnosis was controversial,The diagnosis of the remaining 50 patients is the same after review.3.There were 56 cases in the recurrent/refractory group,accounting for35.2%.Compared with non-relapsed/non-refractory DLBCL patients,there was no significant difference in age,gender,ethnicity,family history of cancer and hepatitis B virus infection.4.Patients in the relapsed/refractory group had more extranodal involvement,higher incidence of B symptoms,higher IPI score,later clinical stage,and more combined masses than the non-relapsed/non-refractory group(P<0.05),but there was no statistical difference among the in the initial position(nodal or extranodal)and the first symptom.5.Compared with non-refractory/non-refractory group,patients with relapsed/refractory group had more hypoproteinemia,elevated LDH,elevated ?2-microglobulin and lower lymphocyte absolute value(P <0.05)),but there is no statistical difference between the two groups with or without anemia.6.Myc,Bcl-2,CD5,Ki-67 were detected in only part of patients with recurrent/refractory and non-recurrent/non-refractory group,and there was no significant difference in tumor cell origin,CD5 expression,Ki-67 expression and double/triple expression between the two groups.Conclusion 1.number of extranodal invasion>1,high IPI score,late clinical stage,large mass,combined with B symptoms,hypoproteinemia,elevated LDH,elevated ?2-microglobulin,increased absolute lymphocyte at the first visit are all risk factors for relapsed/refractory DLBCL,so we should pay attention as soon as possible to these patients in clinical work,totake timely individualized,high-intensity treatment programs depending on the circumstances of the patient to improve patient outcomes.2.DLBCL is a group of non-Hodgkin's lymphomas that are significantly heterogeneous in epidemiology,histology,immunophenotypes,genetic characteristics,clinical manifestations,biological behaviors,therapeutic effects,and prognosis.With the development of molecular genetics and immunophenotyping technology,its value in judging the prognosis of DLBCL has been confirmed by research at home and abroad.So we should accelerate the development of molecular genetic diagnosis techniques to improve the accuracy of DLBCL molecular typing diagnosis and standardize the screening of high risk factors for DLBCL,so as better to guide clinical treatment.