血红蛋白水平在弥漫大B细胞淋巴瘤中的预后评估价值
Prognostic value of hemoglobin in diffuse large B-cell lymphoma
陈玺丞 1葛洪峰 2王玲 3史玉叶 4张颢 5朱俊峰 6单慧蓉 7沈子园 8桑威1
作者信息
- 1. 徐州医科大学附属医院血液科,江苏 徐州 221002
- 2. 安徽医科大学附属亳州医院血液科,安徽 亳州 236800
- 3. 泰安市中心医院血液科,山东 泰安 271000
- 4. 淮安市第一人民医院血液科,江苏 淮安 223000
- 5. 济宁医学院附属医院血液科,山东 济宁 272000
- 6. 蚌埠医学院第一附属医院血液科,安徽 蚌埠 233099
- 7. 沭阳县中医院血液科,江苏 沭阳 223600
- 8. 安徽医科大学公共卫生学院流行病与卫生统计学系,安徽 合肥 230022
- 折叠
摘要
目的 探讨血红蛋白(HGB)水平对弥漫大B细胞淋巴瘤(DLBCL)患者的预后判断价值.方法 回顾性收集 2013 年 3 月—2022 年 7 月淮海淋巴瘤协作组中 6 家医疗中心总计 848 例DLBCL患者的临床资料.基于最大选择秩统计量(Maxstat)确定血红蛋白的最佳截断值,根据截断值将患者分为 2 组;采用倾向性评分匹配(PSM)将 2 组患者进行 1 ∶ 1 最邻近匹配;使用Cox比例风险模型进行单因素和多因素分析;Kaplan-Meier用于绘制生存曲线,组间比较采用 Log-rank 检验.结果 患者的中位年龄为 61 岁(15～91 岁),男性患者占比50.8%,5 年生存率为 64.8%.血红蛋白的最佳截断值为 110 g/L,据此截断值将患者分为 2 组(HGB＜110 g/L组和HGB≥110 g/L组).经PSM分析后,2 组间除了白蛋白水平的差异有统计学意义(P＜0.05),其余各变量差异均无统计学意义(P＞0.05).多因素分析表明,血红蛋白水平、年龄、中枢受累和B细胞淋巴瘤因子-2(BCL-2)表达是影响DLBCL患者预后的独立因素.此外,在 BCL-2+组、BCL-6-组、CD5+组、非生发中心B细胞起源(Non-GCB)组、美国东部肿瘤协作组体力状况(ECOG PS)评分＜2 组和国际综合癌症网络国际预后指数(NCCN-IPI)中高危组中,低血红蛋白水平的患者预后较差.结论 低血红蛋白水平是DLBCL患者预后不良的影响因素.
Abstract
Objective To discuss the prognostic value of hemoglobin(HGB)on patients with diffuse large B-cell lymphoma(DLBCL).Methods A total of 848 DLBCL patients from six medical centers of Huaihai Lymphoma Working Group from March 2013 to July 2022 were selected and their clinical data were retrospective analyzed.The optimal cutoff value of hemoglobin was calculated based on the maximum selection rank statistic(Maxstat).According to the cutoff value,the patients were divided into two groups,and matched with the closest neighbor at 1 ∶ 1 using a propensity score matching(PSM)method.Univariable and multivariable analysis were conducted using Cox proportional risk models.Kaplan Meier survival curves were plotted,and log rank test was used for comparison.Results The median age of patients was 61 years(15-91 years),with 50.8%of male patients,and a 5-year survival rate of 64.8%.The optimal cutoff value for hemoglobin was 110 g/L,and the patients were divided into two groups according to the cutoff value(HGB＜110 g/L;HGB≥110 g/L).After PSM analysis,there was no statistical difference in each variable between the two groups except albumin level(P＜0.05).Multivariable regression showed that hemoglobin level,age,central involvement,and B-cell lymphoma-2(BCL-2)were independent factors for the prognosis of DLBCL patients.In addition,patients with low hemoglobin levels had a poor prognosis in the BCL-2+group,BCL-6-group,CD5+ group,non-germinal center B-cell(Non-GCB)group,Eastern Cooperative Oncology Group Performance Status(ECOG PS)score＜2 group,and National Comprehensive Cancer Network International Prognostic Index(NCCN-IPI)medium and high-risk groups.Conclusions Low hemoglobin level was an adverse prognostic factor in patients with DLBCL.
关键词
弥漫大B细胞淋巴瘤/血红蛋白/预后/多中心研究/倾向性评分匹配Key words
diffuse large B-cell lymphoma/hemoglobin/prognosis/multicenter study/propensity score matching引用本文复制引用
基金项目
江苏省青年医学重点人才项目(QNRC2016791)
江苏省自然科学基金(BK20171181)
江苏省科技厅社会发展重点项目(BE2019638)
出版年
2024
NETL
NSTL
维普
万方数据