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背景与目的:目前,按标准方案治疗晚期霍奇金淋巴瘤(HodgkinNslymphoma,HL)治愈率可达60%。晚期HL国际预后因素课题组研究总结出晚期初治HL的7个不良预后因素:男性、年龄≥45岁、Ⅳ期、白细胞增高、淋巴细胞减少、低血红蛋白、低白蛋白,并据此提出了国际预后分数(internationalprognosticscore,IPS)的概念。本研究旨在探索应用IPS预测晚期HL预后的价值。方法:回顾性分析1980年1月至2004年12月中山大学肿瘤防治中心初次治疗的141例晚期HL,按照确诊时患者不良预后因素的数目计算IPS。采用Kaplan-Meier法进行生存分析,生存率的比较用log-rank检验,采用Cox部分风险模型进行多因素分析,按IPS分组计算生存率并进行生存率比较。结果:141例晚期HL患者5年无失败生存率(failurefreesurvival,FFS)为57.6%,5年总生存率(overallsurvival,OS)为68.1%。IPS=0～1、2、3和IPS≥4组的5年FFS分别为67.7%、63.2%、61.8%、34.9%;5年OS分别为81.0%、75.5%、70.3%、42.3%。低危患者(IPS0～2)和高危患者(IPS≥3)5年FFS分别为65.4%和48.9%(P=0.012);5年OS分别为78.4%和57.1%(P=0.004)。接受ABVD方案[阿霉素(A)、博来霉素(B)、长春花碱(V)、氮烯咪胺(D)]或MOPP方案[氮芥(M)、长春新碱(O)、甲基苄肼(P)、强的松(P)]治疗的低危患者的5年OS均优于高危患者;接受ABVD治疗的高危晚期HL患者5年FFS和OS均显著优于接受MOPP方案治疗者。多因素分析显示B症状、结外病变、接受MOPP方案化疗为晚期HLFFS和OS独立预后不良因素。结论:IPS对晚期HL的预后有较好的预测价值;高危晚期HL患者接受MOPP方案化疗生存比接受ABVD方案差,推荐接受ABVD方案或更强的方案化疗。
Background and Objective: Currently, the standard treatment of advanced Hodgkin’s lymphoma (HodgkinNslymphoma, HL) cure rate of 60%. Advanced HL international prognostic factors group study concluded that the early treatment of advanced HL seven adverse prognostic factors: male, age ≥ 45 years, stage Ⅳ, leukocytosis, lymphopenia, low hemoglobin, low albumin, and accordingly proposed International prognostic score (internationalprognosticscore, IPS) concept. The purpose of this study was to explore the value of using IPS to predict the prognosis of advanced HL. Methods: A retrospective analysis of 141 patients with advanced HL treated at Sun Yat-sen University Cancer Center from January 1980 to December 2004 was performed and IPS was calculated according to the number of adverse prognostic factors at the time of diagnosis. Survival analysis was performed by Kaplan-Meier method. The survival rate was compared by log-rank test and multivariate analysis using Cox partial risk model. The survival rate was calculated by IPS grouping and survival rate was compared. Results: The 141 patients with advanced HL had a 5-year failure rate of 57.6% (FFS) and a 5-year overall survival 68.1%. The 5-year FFS was 67.7%, 63.2%, 61.8% and 34.9% in IPS = 0 ~ 1,2,3 and IPS≥4 groups, respectively; the 5-year OS was 81.0%, 75.5%, 70.3% and 42.3%, respectively. The 5-year FFS for low-risk patients (IPS0 ~ 2) and high-risk patients (IPS≥3) were 65.4% and 48.9%, respectively (P = 0.012). The 5-year OS was 78.4% and 57.1%, respectively. Patients receiving ABVD regimen [doxorubicin (A), bleomycin (B), vinblastine (V), dacarbazine (D)] or MOPP regimen [ , Procarbazine (P), prednisone (P)] were better than high-risk patients in 5-year OS. The 5-year FFS and OS of high-risk HL patients receiving ABVD were significantly better than those receiving MOPP Program treatment. Multivariate analysis showed that the symptoms of B, extranodal disease, MOPP regimen chemotherapy for advanced HLFFS and OS independent prognostic factors. Conclusion: IPS has a good predictive value for the prognosis of advanced HL. The high-risk stage HL patients receiving MOPP regimen have worse survival than those receiving ABVD, and ABVD regimen or more regimen chemotherapy is recommended.