| Objective:Retrospectively analyze the clinical data of patients with diffuse large B-cell lymphoma,compare the efficacy of CHOP and R-CHOP programs,and explore the risk factors that affect prognosis.Methods:The clinical data of 169 patients with diffuse large B-cell lymphoma were diagnosed by pathology and immunohistochemistry in our hospital from January 2008 to December 2019 were collected to analyze the clinical characteristics.According to different chemotherapy programs,117 newly-treated patients who met the inclusion criteria were divided into CHOP group(n=60)and R-CHOP group(n=57),and the clinical data of the two groups were compared.All patients were treated for 21 days as a chemotherapy cycle,and received more than 4 cycles of treatment.After the chemotherapy was completed,the efficacy of the two groups of programs was compared.The therapeutic effect of the two groups was further analyzed after pathological classification IPI score and age stratification.All patients were followed up to observe the survival rate and progression-free survival rate of patients,and to analyze the relationship between age,clinical stage,IPI score,pathological classification,serum LDH,?2-microglobulin,transplantation,chemotherapy cycle and prognosis.Use SPSS26.0 software to process the data,count data using chi-square test,rank data using student's t and rank sum test,use Kaplan-Meier method to analyze the single factor affecting the prognosis and draw survival curve,multi-factor analysis using COX regression model,P <0.05 Statistical significance.Results:1.Of the 169 newly diagnosed patients,101 were male,accounting for 59.8%,and 68 were female,accounting for 40.2%.The maximum age is 86 years old,the minimum age is 7 years old,the median age is 56 years old,and the average age is 54±16.01 years old.62 cases of primary nodules accounted for 36.7%;107 cases of extranodal patients accounted for 63.3%,including 31 cases of gastrointestinal tract,26 cases of Webster's ring,8 cases of skin,9 cases of nasal cavity and sinuses,6 cases of spleen.4 cases each for central nerve system and mammary glands,3 cases each for adrenal gland and bone,2 cases each for testis,mediastinum,parotid gland,submandibular gland,1 case each of thyroid,kidney,chestwall,uterus and ovary.2.Among the 60 patients in the CHOP group,19 had complete remission and 25 had partial remission.The CR rate was 31.7%,the PR rate was 41.7%,and the total effective rate was 73.4%;among the 57 patients in the R-CHOP group,33 had complete remission and 17 had partial remission.The CR rate was 57.9%,the PR rate was 41.7%,and the total effective rate was 87.7%;the difference in CR rate between the two groups was statistically significant(P <0.05).With a median follow-up of 49 months,the 3-year and 5-year survival rates of the CHOP group were 67.5% and 49.3%,and the 3-year and 5-year progression-free survival rates were 63.1% and 36.5%,respectively.The median survival time was 59 months and average OS time was 79 months.The 3-year and 5-year survival rates of the R-CHOP group were 87.2% and 73.2%,respectively.The 3-year and 5-year progression-free survival rates were 79.2% and 67.4%,respectively.The median survival time was not reached,and the average OS time was 105 mouths.The difference in survival rates between the two groups was statistically significant(P <0.05).3.According to the stratified analysis of risk factors related to prognosis,the results showed that:in the GCB patients,8 patients in the CHOP group had complete remission,CR rate was 44.4%,15 patients in the R-CHOP group had complete remission,CR rate was65.2%.There was no significant difference in CR rate,OS rate and PFS rate between the two groups(P> 0.05).In the non-GCB patients,6 patients in the CHOP group had complete remission,CR rate was 18.2%,and 14 patients in the R-CHOP group had complete remission,CR rate was 63.6%.The differences in CR rate,OS rate and PFS rate between the two groups were statistically significant(P <0.05).Among patients aged ?60 years,10 patients in the CHOP group(36 patients)had complete remission with a CR rate of 27.7%,and 26 patients in the R-CHOP group(39 patients)had complete remission with a CR rate of 66.7%,and the difference in CR rate and PFS rate between the two groups was statistically significant(P <0.05);Among patients aged >60 years,7 patients in the CHOP group(24 patients)had complete remission with a CR rate of 29.2%,and 8 patients in the R-CHOP group(18patients)had complete remission with a CR rate of 44.4%.There was no statistically significant difference in CR rate,OS rate and PFS rate between the two groups(P <0.05).Among the patients with an IPI score of 0-2,12 patients in the CHOP group(33 patients)had complete remission,and 25 patients in the R-CHOP group(35 patients)had complete remission.The CR rates were 36.3% and 71.4%,respectively.The difference in CR rate and PFS rate between the two groups was statistically significant(P < 0.05);Among the patients with an IPI score of 3-5,4 patients in the CHOP group(20 patients)had complete remission,and 8 patients in the R-CHOP group(18 patients)had complete remission.The CR rates were20% and 44.4%.There was no statistically significant difference in CR rate and OS rate between the two groups(P> 0.05).4.Using single factor analysis,the results showed that the 2-,3-,and 5-year survival rates of stage ? and ? patients were higher than those of stage ? and ?,which were 97.1%,93.9%,76% and 87.9%,67.2% and 49.6%,respectively.The 5-year survival rate of patients with low IPI score was higher than that with high IPI score(69.5% VS 37.9%);age ?60 years group was higher than age> 60 years group(68% VS 43%);non-GCB type was lower than GCB Type(49% VS73.5%);the transplanted group was higher than the non-transplanted group(78.8% VS54%).The patient's age,IPI score,clinical stage,pathological classification,and whether transplantation were statistically significant(P <0.05),but there was no statistically significant difference in chemotherapy cycle,lactate dehydrogenase,and?2-microglobulin levels(P> 0.05).Further multi-factor COX regression model analysis showed that clinical staging was an independent risk factor affecting the long-term survival of patients in this study(P <0.05).5.The 117 patients in this study had a 3-year overall survival rate was 75.8%,a 5-year survival rate was 58.3%,and an average survival time was 89 months.Conclusions:1.Diffuse large B-cell lymphoma can occur in all ages,the majority of middle-aged and elderly people,more men than women.Occurs in lymph nodes,but is often accompanied by extranodal invasion,mainly involving the gastrointestinal tract and Webster's ring.2.For newly treated patients with diffuse large B-cell lymphoma,R-CHOP regimen not only obtains good short-term efficacy,but also prolongs survival and progression time,which is the preferred chemotherapy regimen for DLBCL.3.3.For young,non-GCB type and low-risk / medium-low-risk patients,the use ofR-CHOP regimen can improve the CR rate and prolong the disease progression time.4.Age> 60 years,clinical stage?/?,non-GCB type,high IPI score(3-5 points),and non-transplantation are adverse factors that affect the prognosis of diffuse large B-cell lymphoma.factor.Clinical stage is the most dangerous factor affecting the survival of patients. |
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