| Objcetive:To analyse the clinical characteristics of diffuse large B cell lymphoma(DLBCL)patient with hepatitis B virus(HBV)infection,and to explore the prognostic factors of these patients;TO analyse the prognostic value of the High-sensitivity modified Glasgow prognostic score(HS-mGPS)in DLBCL patients with HBV infection to provide evidences for individualized therapy.Methods:1.We performed a retrospective study included 271 patients who were newly diagnosed of DLBCL between January 2013 to March 2020,and summarized the clinical characteristics and toxic side effects of patients such as age,sex,Ann Arbor stage,B symptoms,myelosuppression,hepatic impairment,HBV reactivation and so on,and analysis the relationship between HBV infection and the factor we mention above.Use chi-square test to compare categorical variables,use Kaplan-Meier method for survival analysis,and compare differences by log-rank test,and meaningful single factor was used to carry out Cox proportional hazards Mode.P<0.05 is statistically different.2.Calculated the HS-mGPS of DLBCL patients with HBV infection and divided into3group:0 score group(n=57),1 score group(n=40)and 2 score group(n=20)according to the scores,and analysis the relationship between HS-mGPS and clinical characteristics.Univariate and multivariate analysis were used to evaluate the prognostic value of HS-mGPS.Use chi-square test to compare categorical variables,use Kaplan-Meier method for survival analysis,and compare differences by log-rank test,and meaningful single factor was used to carry out Cox proportional hazards Mode.P<0.05 is statistically different.Results:1.Clinical characteristics and prognostic factors of DLBCL patients with HBV infection:(1)General characteristics:The study population included 271 patients(148 males and 123 females)with a median age of 58 years(range 18?89).We classified the patients as HBV infection group which includes 117 cases(43.2%)and control group which includes 154 cases(56.8%)according to the infection of HBV.The median age of the two groups were 57 and 60 years,respectively.We founded it younger age(<60years)(χ~2=3.984,P=0.046),higher IPI risk group(χ~2=13.188,P=0.001)and advanced Ann Arbor stage(III-IV)(χ~2=5.618,P=0.018)were more frequent in patients with HBV infection compared to the control group.Other characteristics showed no significant differences between the two groups.108 patients were accepted immunohistochemistry test of c-myc、Bcl-2 and Bcl-6.20 patients(18.5%)were double-expression and 11(10.2%)were triple-expression.We found it no difference both double-expression and triple-expression between the infection group and control group(P>0.05).(2)Recent efficacy analysis:The overall response rate shows no difference between the two groups(P=0.705).(3)Long-term efficacy analysis:40 cases died up to the end of follow-up,and the 5-year OS rate were 85.2%.The 5-year OS rate of infection group and control group were 76.9%and 91.6%,respectively(χ~2=10.090,P=0.001).(4)Toxic side effects:Myelosuppression is the most common side effect,with an incidence of 70.8%(192/271).Both myelosuppression(P=0.765)and severe myelosuppression(III-IV)(P=0.484)show no difference between HBV infection group and control group.The second common one was hepatic impairment.The total incidence rate was 29.9%(81/271),and we devide infetion group into two groups:current infection group and previous infection group.The incidence of hepatic impairment in the current infection group was higher than the previous infection group and the control group(χ~2=13.140,P=0.001),but it shows no difference in severe hepatic impairment(III-IV)between the three groups(P=0.635).And we also found it no difference in HBV reactivation between the current infection group and previous infection group(P=0.475).(5)Survival analysis:Cox regression analysis showed that HBV infection is an independent prognostic factor in DLBCL patients.And the cox regression analysis showed that non-GCB type,high IPI score and regimen without rituximab were independent factors for poor prognosis in HBV+DLBCL(P<0.05).2.Analysis of the prognostic value of HS-mGPS in DLBCL patients with HBV infection:(1)General characteristics:According to HS-mGPS classification,57 HBV+DLBCL patients(48.7%)had a score of 0,40(34.2%)had a score of 1,and 20(17.1%)had a score of 2.We found that high HS-mGPS were associated with unfavorable IPI scores(χ~2=10.671,P=0.031).(2)Survival analysis:Patients with HS-mGPS of 0 had significantly better 5-year OS than those with HSmGPS=1 and those with HS-mGPS=2(χ~2=8.958,P=0.011).IPI and HS-mGPS were entered for Cox regression analysis,which showed that high HS-mGPS was independent factors for poor prognosis in DLBCL patients with HBV infection.(P<0.05).Conclusion:1.HBV infection is an independent prognostic factor in DLBCL patients,HBV+DLBCL should be classified as a new subtype.2.non-GCB type,high IPI score and regimen without rituximab were independent factors of HBV+DLBCL prognosis.3.High HS-mGPS was independent factors for poor prognosis in DLBCL patients with HBV infection and HS-mGPS play a good role in evaluating prognosis in HBV+DLBCL. |
