摘要探讨伴TP53突变弥漫大B细胞淋巴瘤（DLBCL）临床病理特征和预后影响因素。回顾性分析2006年1月至2023年6月在中国医学科学院肿瘤医院和中国医学科学院肿瘤医院深圳医院采用R-CHOP（利妥昔单抗+环磷酰胺+多柔比星+长春新碱+泼尼松）方案治疗的86例和R-CHOP样方案治疗的19例初治DLBCL患者资料。采用多因素Cox回归模型分析评估预后影响因素。105例患者中，男56例（53.3%）；中位年龄59岁；Ⅰ~Ⅱ期54例，Ⅲ~Ⅳ期51例；B细胞淋巴瘤2（BCL2）基因扩增比例为9.5%（10/105）。R-CHOP方案治疗的完全缓解率为28.6%（30/105），中位无进展生存时间（PFS）为10.1（95% CI：7.3~13.0）个月，中位总生存时间（OS）未达到。Ⅲ~Ⅳ期是影响患者OS的危险因素（ HR=2.80，95% CI：1.04~7.54），乳酸脱氢酶（LDH）升高是影响患者PFS（ HR=2.86，95% CI：1.56~5.26）和OS（ HR=2.90，95% CI：1.08~7.69）的危险因素。BCL2扩增患者的中位PFS（95% CI）低于未扩增患者［4.0（2.7~5.3）比11.3（8.5~14.1）个月， P=0.011］。31例（57.4%）Ⅰ~Ⅱ期患者在R-CHOP方案基础上采用综合治疗。Ⅲ~Ⅳ期和LDH增高是TP53突变DLBCL患者预后不良的相关因素，伴有BCL2基因扩增的患者预后较差，Ⅰ~Ⅱ期患者在R-CHOP方案基础上采用综合治疗模式可能改善预后。

abstractsExploring the clinical and pathological characteristics and prognostic factors of diffuse large B-cell lymphoma (DLBCL) patients with TP53 mutation. Data of 86 DLBCL patients with TP53 mutation treated with R-CHOP and 19 DLBCL patients with TP53 mutation treated with R-CHOP like regimen as first-line treatment at the Cancer Hospital of Chinese Academy of Medical Sciences (CAMS) and the Cancer Hospital of the CAMS in Shenzhen, China, from January 2006 to June 2023 were retrospectively analyzed. Multivariate Cox analysis was applied to assess the effects of the factors on survival. Among the 105 DLBCL patients with TP53 mutation, 56 were male (53.3%); the median age was 59 years. There were 54 cases with stage Ⅰ-Ⅱ and 51 cases with stage Ⅲ-Ⅳ diseases. The proportion of B-cell lymphoma 2 (BCL2) gene amplification was 9.5% (10/105). The complete response rate in the whole group of patients treated with the R-CHOP regimen was 28.6% (30/105). The median progression-free survival (PFS) was 10.1 (95% CI: 7.3-13.0) months, and the median overall survival (OS) was not reached. Stage Ⅲ-Ⅳ was a risk factor for OS ( HR=2.80, 95% CI: 1.04-7.54), and elevated lactic dehydrogenase (LDH) was a risk factor for PFS ( HR=2.86, 95% CI: 1.56-5.26) and OS ( HR=2.90, 95% CI: 1.08-7.69). The median PFS was lower in patients with BCL2 amplification than in patients without amplification [4.0 (95% CI: 2.7-5.3) vs 11.3 (95% CI: 8.5-14.1) months, P=0.011]. Thirty-one of the 54 (57.4%) patients with stage Ⅰ-Ⅱ disease received combination therapy based on the R-CHOP protocol. In conclusion, stage Ⅲ-Ⅳ and elevated LDH were associated with poor prognosis in TP53 mutation DLBCL patients, and patients with BCL2 amplification had a poor prognosis. For TP53 mutation DLBCL patients with stage Ⅰ-Ⅱ disease, combination of therapeutic modalities based on the R-CHOP may improve the prognosis.