摘要目的 评价应用CHOP方案治疗超年龄80岁及以上非特异型外周T细胞淋巴瘤(PTCL-U)患者的疗效、化疗不良反应及其预后影响因素. 方法 对2008年1月至2015年1月经广州市第一人民医院病理和免疫组化确诊的57例PTCL-U患者的资料进行回顾性分析,评价CHOP方案的疗效、化疗不良反应及其预后影响因素. 结果 57例PTCL-U患者,应用CHOP方案治疗后,完全缓解11例(19.3％),部分缓解23例(40.4％),疾病稳定14例(24.6％),病情进展9例(1 5.8％),总有效率为59.6％(34例).治疗后1年、2年、3年的总生存率分别为70.2％(40例)、36.8％(21例)及17.5％(10例).中位生存时间为18.2个月.57例患者Ⅰ～Ⅱ度骨髓抑制40例(70.2％),Ⅲ～Ⅳ度17例(29.8％);恶心、呕吐Ⅰ～Ⅱ度49例(86.0％),Ⅲ～Ⅳ度8例(14.0％);肝功能异常7例,心脏毒性2例,凝血异常7例.单因素分析结果显示,碱性磷酸酶、Ki-67指数、淋巴瘤国际预后指数(IPI)积分、结外侵犯部位＞1个、疗效、化疗疗程数是影响老年患者生存时间的预后指标.多因素分析结果显示,IPI评分＞2分(95％CI:1.12～6.35,x2＝5.45,P＜0.01)、淋巴结侵犯部位＞1个(95％CI:2.58～15.32,x2＝16.42,P＜0.01)、病情进展(95％CI:1.82～12.15,x2＝10.23,P＜0.01)、疗程＞4个(5％CI:0.18～0.79,x2＝7.28,P＜0.01)是影响老年PTCL患者中位生存时间的独立危险因素. 结论 年龄大于80岁PTCL-U患者预后不良,CHOP方案治疗有效,不良反应可耐受.IPI评分＞2分、结外侵犯部位＞1个对于预测超高龄PTCL-U患者预后具有重要意义.完成足疗程的化疗,且疗效达到缓解可改善患者生存期.

abstractsObjective To evaluate the efficacy of CHOP (cyclophosphamide,doxorubicin,vincristine,and prednisone)chemotherapy on peripheral T cell lymphomas-unspecified (PTCL-U)in patients aged 80 years and over,and investigate the chemotherapy adverse effects and its prognostic factors.Methods Clinical data of 57 patients with PTCL-U confirmed by pathology and immunohistochemistry in Guangzhou First People's Hospital from January 2008 to January 2015 were retrospectively analyzed.The efficacy and adverse effects of CHOP chemotherapy,and its prognostic factors were evaluated.Results Of 57 patients,11 (19.3％) achieved complete remission,23(40.4％)had partial remission,14(24.6％)had stable disease,and 9(15.8％)had progressive disease after CHOP chemotherapy,with a total effective rate of 59.6％ (34 cases).The expected 1-year,2-year and 3-year overall survival(OS)rate was 70.2％ (40 cases),36.8％ (21 cases) and 17.5％ (10 cases),respectively.The median survival time was 18.2 months.Among the 57 patients,40(70.2％) had hypoplasia of bone marrow at degree Ⅰ-Ⅱ,17 (29.8％) at degree Ⅲ-Ⅳ,49 (86.0％) had mild nausea and vomiting(degree Ⅰ-Ⅱ),8(14.0％)had severe nausea and vomiting(degree Ⅲ-Ⅳ),7 had liver dysfunction,2 had cardiac toxicity and 7 had disturbance of blood coagulation.Univariate analysis showed that the alkaline phosphatase,Ki-67 percentage,lymphoma international prognostic index(IPI)score,extranodal involved sites(＞1),as well as the efficacy and course of chemotherapy were the prognostic factors for survival time in very elderly patients.Multivariate analysis indicated that IPI score＞2(95％CI:1.12～6.35,x2 ＝5.45,P＜0.01),extranodal involved sites(＞1)(95％ CI:2.58-15.32,x2 ＝ 16.42,P＜0.01),disease progression(95％CI:1.82～12.15,x2 ＝ 10.23,P＜0.01),chemotherapy courses(＞4) (5％CI:0.18～0.79,x2 ＝7.28,P＜0.01)were the independent prognostic factors for the median survival time in very elderly patients.Conclusions PTCL U patients aged 80 years and over have poor prognosis.CHOP chemotherapy has a certain effect on PTCL-U in very elderly patients,and chemotherapy side effects can be tolerated.IPI score＞2 and extranodal involved sites(＞ 1)are the important prognostic factors in very elderly PTCL-U patients.The completion of full course of chemotherapy with remission occurrence is important to prolong survival time in very elderly PTCL-U patients.