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    血清铁蛋白和临床特征对弥漫性大B细胞淋巴瘤的预后影响:一项淮海淋巴瘤协作组的多中心回顾性研究

    Effects of serum ferritin and clinical characteristics on the prognosis of diffuse large B-cell lymphoma: a multi-center retrospective study of Huaihai Lymphoma Working Group

    • 摘要: 目的 探讨血清铁蛋白及相关临床特征对弥漫性大B细胞淋巴瘤(diffuse large B cell lymphoma, DLBCL)患者的预后影响。 方法 收集2015年3月—2020年11月7家医疗中心确诊的202例初诊DLBCL且具有确切血清铁蛋白数值的患者的一般资料、实验室及影像学检查、免疫组化染色结果,通过Max Stat统计量计算铁蛋白、年龄和白蛋白的最佳截断值,使用Cox比例风险模型进行单因素和多因素分析以确定影响DLBCL患者生存结局的变量并进行亚组分析。结果 202例初诊DLBCL患者中,男性105例(52%)、女性97例(48%),中位年龄58岁,Ann ArborⅠ-Ⅱ期74例(36.6%),中位随访时间36个月。Mann-Whitney U检验结果表明存活组与死亡组患者的血清铁蛋白、年龄及白蛋白的数值差异有统计学意义(P<0.05);血清铁蛋白、年龄和白蛋白的最佳截断值分别为246 μg/L、74岁和38.5 g/L;单因素、多因素分析表明铁蛋白、年龄和东部肿瘤协作组(Eastern Cooperative Oncology Group, ECOG)评分对DLBCL预后有影响;在国际预后指数(international prognostic index, IPI)低危和低中危组中,铁蛋白<246 μg/L和铁蛋白≥246 μg/L患者总生存期(overall survival, OS)差异显著(P<0.05),但在BCL-2+组、BCL-6-组、IPI高中危和高危组未发现明显差异。结论 血清铁蛋白是DLBCL患者的不良预后因素,有助于区分IPI低风险患者中的预后较差者。

       

      Abstract: Objective To investigate the effect of serum ferritin and related clinical characteristics on the prognosis of patients with diffuse large B-cell lymphoma (DLBCL). Methods Data were collected from 202 patients who were originally diagnosed with DLBCL with exact serum ferritin values from seven medical centers from March 2015 to November 2020. The optimal cutoff values of ferritin, age and albumin were calculated by Max Stat statistics. Univariable and multivariable analyses were performed using the Cox proportional risk model to determine the variables affecting the survival outcome of patients with DLBCL and subgroup analysis was performed. Results Among the 202 newly diagnosed DLBCL patients, 105 (52%) were men and 97 (48%) were women. The median age was 58 years old, and 74 cases (36.6%) were at the Ann Arbor Ⅰ-Ⅱ stage. The median follow-up time was 36 months. According to Mann-Whitney U test, there were statistical differences in serum ferritin, age and albumin between the survival group and the death group (P<0.05). The optimal cut-off values of serum ferritin, age and albumin were 246 μg/L, 74 years and 38.5 g/L, respectively. Univariate and multivariate analysis showed that ferritin, age and Eastern Cooperative Oncology Group (ECOG) score exerted impacts on the prognosis of DLBCL. In the low-risk and low/medium-risk international prognostic index (IPI) groups, the overall survival (OS) was remarkably different between patients with ferritin <246 μg/L and ferritin≥246 μg/L (P<0.05), but no significant difference was found in the Bcl-2+, Bcl-6-group, IPI high-risk group and IPI high-risk group. Conclusions Serum ferritin is a poor prognostic factor in DLBCL patients and can assist to distinguish poor prognostic patients among those with low risk of IPI.

       

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