| Objective: This study attempted to investigate the clinical characteristics of diffuse large B-cell lymphoma (DLBCL) and performed a retrospective analysis of the relationship between the clinical factors and prognosis of DLBCL.Patients and methods: We carried out a retrospective study of 375 consecutive patients newly diagnosed with DLBCL at Hebei Medical University Fourth Hospital, from January 2002 to September 2010. Collect the data of every patient, including clinical state, laboratory examinations, therapeutic regimen and evaluation of therapeutic results. Patients were followed up in clinic and/or by telephone. The results were analyzed by SPSS 17.0 software. Survival times were analyzed with univariate Kaplan-Meier analysis and survival comparisons were measured by Log-rank tests. Multivariate Cox proportional hazard models were used to investigate the risk factors of DLBCL. Values of P<0.05 were considered statistically significant.Results:(1) Out of 375 DLBCL cases,male to female ratio was 1.1: 1. The median age at onset was 56 years old, and 147 cases (39.2%) were more than 60 years old. 263 cases (70.13%) were detected in nodal involvement and the most common site of nodal involvement was in the cervical part (56.65%). There were 221 cases (58.93%) in extranodal sites and the most common site of extranodal involvement was bone marrow (65.61%). The common symptoms at onste were superficial lymphadenectasis, B symptoms, deep lesion, gastrointestinal symptoms and paresthesia. According to the Ann Arbor Staging Classification, there were 100 cases with stage I/II (27.03%), 270 cases with stage III/IV (72.97%), and 5 cases were not classified. There were 163 cases (43.47%) with B symptoms, 212 cases (56.53%) without B symptoms. Patients newly diagnosed with DLBCL had a kind or more underlying diseases, or had a second cancer, mainly the diseases of cardiovascular system and endocrine system. Chemotherapy was taken as the main treatment and CHOP, CHOP-like or R-CHOP was used as the first-choice treatment. There were 88 cases (23.47%) treated with R-CHOP.(2) In the whole group, 298 cases went into complete remission (CR) or partial remission (PR), and overall response rate was 79.47%. There were 158 cases of relapse, and the relapse rate was 56.23%. There were 174 death cases, and the mortality rate was 46.4%. Among 375 cases, five-year OS, PFS and DFS rates were 33.0%, 35.0% and 45.0%, respectively.(3) In the univariate analysis of 375 cases, the results showed that age, PS, clinical stage, the number of extranodal sites, LDH, IPI score, B symptoms,β2-MG, ALB, ESR, Hb level before treatment, CRP, treatment protocols and ALC at diagnosis were prognostic factors for OS and PFS, and clinical stage, the number of extranodal sites, LDH, IPI score, B symptoms,β2-MG, ALB, ESR, ALC at diagnosis were prognostic factors for DFS.(4) In the univariate analysis of 88 cases treated with R-CHOP, prognostic factors for OS were: ALC at diagnosis, IPI, R-IPI and ALC/R-IPI score. The following were also statistically significant for PFS: ALC at diagnosis, IPI and ALC/R-IPI score. Prognostic factors for DFS were: ALC at diagnosis (0.8×109/L) and ALC/R-IPI score.(5) A multivariate analysis of prognostic factors which were statistically significant in the univariate analysis was performed using the Cox proportional hazard models. The results showed that LDH and B symptoms were independent prognostic factors, and patients with elevated serum LDH and B symptoms had a shorter OS. The independent prognostic factors associated with PFS were clinical stage, LDH and B symptoms. Patients with stageⅢ~Ⅳ, elevated serum LDH and B symptoms had a shorter PFS. Clinical stage and B symptoms were independent prognostic factors for DFS and patients with stageⅢ~Ⅳor B symptoms had a shorter DFS. Conclusion:(1) In our series, DLBCL occurred mainly in older people, and appeared to have a preponderance of male than female. The most common sites of nodal and extranodal involvement were in the cervical part and bone marrow, respectively. The most common symptom at onste was superficial lymphadenectasis. The proportion of patients with stageⅢ~Ⅳwas more than 2/3. More than half of patients at diagnosis had a kind or more underlying diseases.(2) The overall response rate was about 80%, and the relapse rate was more than 50%. The 5-year rates of OS, PFS and DFS were 33.0%, 35.0%, and 45.0%, respectively.(3) Univariate analysis identified the following parameters as adversely influencing OS and PFS: age>60, PS>1, advanced stageⅢ~Ⅳ, two or more extranodal sites, elevated serum LDH, B symptoms, highβ2-MG level, IPI score≥2, low ALB level, high ESR level, anemia, high CRP level, ALC<1×10~9/L or ALC<0.8×10~9/L.(4) ALC at diagnosis and ALC/R-IPI score were prognostic factors for OS, PFS and DFS in DLBCL treated with R-CHOP.(5) Multivariate analysis identified that serum LDH level and B symptoms were independent prognostic factors for OS. Clinical stage, LDH and B symptoms were independent prognostic factors for PFS. Clinical stage, and B symptoms were independent prognostic factors for DFS. |
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