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探索应用国际预后评分(IPS)预测进展期霍奇金淋巴瘤(HL)预后的可行性。方法回顾性分析2001年1月～2004年12月中国医学科学院肿瘤医院初次治疗的95例进展期HL,按照确诊时患者不良预后因素的数目计算IPS。采用KaplanMeier法进行生存分析。生存率的比较用log-rank检验,分层研究各亚组的预后意义,按IPS分组计算生存率并进行生存率比较。结果95例进展期HL患者5年无失败生存率(FFS)为64.5%,5年总生存率(OS)为75.3%。按照国际标准分为进展期HL低危病组(IPS 0～2组)和高危病组(IPS≥3组),5年FFS分别为72.0%和33.5%(P=0.041);5年OS分别为77.3%和66.77%(P=0.425)。IPS=0分、1～2分和IPSI≥3分组的5年FFS分别为91.7%、68.3%、33.3%;5年OS分别为91.7%、74.6%、66.7%。单因素分析显示:对FPS有预后意义的因素有血红蛋白水平、血浆白蛋白水平;对OS有预后意义的因素有性别、B症状治疗模式及治疗方案。接受ABVD方案[阿霉素(A)、博来霉素(B)、长春花碱(V)、氮烯咪胺(D)]治疗的进展期HL患者FFS显著优于接受非ABVD方案治疗者,增加剂量化疗和造血干细胞移植的疗效较好,对于高危患者是一种可以选择的治疗方法。结论IPS对进展期HL的预后有较好的预测价值,高危进展期HL患者接受ABVD方案化疗组生存率较接受非ABVD方案化疗组好,因此对于进展期HL推荐应用ABVD方案或更强的方案化疗。
To explore the feasibility of predicting the prognosis of advanced Hodgkin’s lymphoma (HL) by international prognostic score (IPS). Methods The clinical data of 95 patients with advanced HL who were treated at Cancer Hospital of Chinese Academy of Medical Sciences from January 2001 to December 2004 were retrospectively analyzed. IPS was calculated according to the number of adverse prognostic factors at the time of diagnosis. Survival analysis was performed using the KaplanMeier method. Survival rates were compared by log-rank test, and the prognostic significance of each subgroup was studied by stratification. The survival rate was calculated by IPS grouping and the survival rate was compared. Results The 5-year failure-free survival (FFS) of 95 patients with advanced HL was 64.5%, and the 5-year overall survival was 75.3%. The 5-year FFS was 72.0% and 33.5% (P = 0.041), respectively. According to the international standards, the 5-year OS was divided into advanced stage low-risk disease group (IPS 0-2 group) and high risk group (IPS≥3 group) 77.3% and 66.77% (P = 0.425). The 5-year FFS of IPS = 0, 1 ~ 2 and IPSI≥3 were 91.7%, 68.3% and 33.3%, respectively. The 5-year OS was 91.7%, 74.6% and 66.7%, respectively. Univariate analysis showed that there are hemoglobin and plasma albumin levels in prognostic significance of FPS. There are gender, B treatment modalities and treatment options for OS in prognosis. Patients with advanced HL treated with the ABVD regimen (doxorubicin (A), bleomycin (B), vinblastine (V), dacarbazine) were significantly better than those treated with non-ABVD regimens , Increasing doses of chemotherapy and hematopoietic stem cell transplantation is effective, high-risk patients is an alternative treatment. Conclusions IPS has a good predictive value for the prognosis of advanced HL. The survival rate of patients receiving ABVD regimen in high-risk stage HL patients is better than non-ABVD regimen chemotherapy regimens, so ABVD regimen or more regimen recommended for advanced HL Chemotherapy.