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83 例弥漫大 B 细胞淋巴瘤的 临床特征及预后相关因素分析. 北京大学第三医院血液科 王晶 克晓燕. 弥漫大 B 细胞淋巴瘤 (diffuse large B-cell lymphoma , DLBCL) 是成人最常见的非霍奇金淋巴瘤。. 通过联合化疗以及新药单克隆抗体的协同治疗,大约 60% 的患者可以得到临床缓解,但仍有 40% 的患者出现原发耐药或者在缓解后复发。. 生发中心( Germinal Center, GC )来源 非生发中心( non-GC )来源. GC 来源的患者预后明显较好. 病例和方法. 病例来源. - PowerPoint PPT Presentation
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一般临床资料 按照 Ann Arbor 分期( Costwold 修订)对患者进行临床分期
评估患者 IPI 评分,并通过得分将患者分为四个不同危险程度的组群,①低危组 0-1 分 ②低中危组 2 分 ③高中危组 3 分 ④高危组 4分。
Primary Onset Locations of DLBCL
Location No Percent (%)
Lymph Node 24 28.9Extranodal sites
Gastrointestinal Tract 24 28.9
Head 8 9.8Tonsil 6 7.2Testis 4 4.8Skin 3 3.6Nasal Cavity 2 2.4Thyroid 2 2.4Thoracic Vertebrae 2 2.4Eyes and Ocular Adnexa 1 1.2
Bone Marrow 1 1.2Others 6 7.2
Total 83 100
Organ involvement in patients with DLBCL
Organ involved
This report tissue involvement
of all patients
Conconi et al(Hematol. Oncol. 2000)
Tissue involvement of All patients
n % n %
Lymph nodes 61 41.5 40 35
Extranodal sites
Gastrointestinal tract 24 16.3 24 22
Bone marrow 5 3.4 22 20
Spleen 12 8.2 13 12
Liver 5 3.4 12 11
Others# 40 27.2 0 0
Total 147* 100 111 100
P < 0.01
注: # Other tissues involved (case numbers): Head and neck (8); lung (5) ; tonsil (5); testis (4); skin (3); Pancreas (3); kidney (2); thyroid (2); and others tissues (8).
* Tissue involvement: if one patient had two tissues involved, two tissues were counted.
DLBCL cases evaluated by the Ann Arbor Staging and International Prognostic Index (IPI)
CasesThis reportall patients
Jerkeman et al(Ann. Hematol. 2004)
All patientsn % n %
Ann Arbor
Ⅰ 15 20 13 8
Ⅱ 14 18 73 42
Ⅲ 11 15 34 20
Ⅳ 36 47 52 30
Sub-total 76 100 172 100
IPI
1 21 31 88 51
2 23 33 51 30
3 16 23 19 11
4 9 13 14 8
Sub-total 69 100 172 100
P < 0.01
P < 0.01
GC AGE65 STAGE β2-MG LDH LN CRP ESR IPI
GC Pearson Correlation Sig. (2-tailed) n
1.
52
AGE65 Pearson Correlation Sig. (2-tailed) n
.160
.25852
1.
63
STAGE Pearson Correlation Sig. (2-tailed) n
.467**.001
50
.018
.89061
1.
61
β2-MG Pearson Correlation Sig. (2-tailed) n
.141
.37342
.150
.28952
.251
.07252
1.
52
LDH Pearson Correlation Sig. (2-tailed) n
.358*.015
46
.269*.043
57
.371**.004
57
.445**.001
50
1.
57
LN Pearson Correlation Sig. (2-tailed) n
-.028.845
52
.047
.71463
.216
.09461
.066
.64452
.139
.30257
1.
63
CRP Pearson Correlation Sig. (2-tailed) n
.265
.16429
.435**.009
35
.459**.006
35
.130
.48631
.516**.002
33
.211
.22435
1.
35
ESR Pearson Correlation Sig. (2-tailed) n
.080
.68129
.329*.047
37
.308
.06437
.078
.66533
.226
.19235
-.140.407
37
.388
.07422
1.
37
IPI Pearson Correlation Sig. (2-tailed) n
.435**.003
46
.273*.040
57
.740**.000
57
.453**.001
50
.597**.000
57
.190
.15757
.389*.025
33
.262
.12835
1.
57
Correlation matrix showing the relationship of variables involved in prognosis of DLBCL
Fig. Survival outcome according to the cell origin. (p = 0.047)
GC: germinal center origin; non-GC: non-germinal center origin, n= patient numbers in each group.
本组实验利用石蜡切片的 CD10 、 Bcl-6 以及MUM1 免疫组化染色将 DLBCL 分为 GC 和
non-GC 两类来源的肿瘤,两种类型的比例为0.72 : 1
与 LDH 、 IPI 的相关性具有统计学意义 与性别、年龄、发病部位、临床分期无相关性
肿瘤细胞来源
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