Objective: This study aimed to investigate the effect of tumor lysis syndrome (TLS) on the prognosis of children and adolescents with intermediate- or high-risk high-grade mature B-cell nonHodgkin lymphoma (HG B-NHL) . Methods: This study collected the clinical data and prognosis of 283 patients aged <18 years with newly diagnosed intermediate- or high-risk HG B-NHL treated at the Sun Yat-sen University Cancer Center from January 2010 to December 2022. The clinical characteristics, laboratory indicators during TLS, and prognosis of the patients were analyzed. The optimal cutoff values of laboratory indicators during TLS were identified using R studio according to event-free survival (EFS) . Results: Of the 283 patients enrolled, the median age was 7 (range: 1-18) years and the male-to-female ratio was 3.6∶1, 76 (26.9%) developed TLS, and 207 (73.1%) did not. Patients with TLS demonstrated higher proportions of the pathological subtype Burkitt lymphoma, high-risk stratification, age <12 years, and LDH of ≥1 000 IU/L compared with patients without TLS (all P<0.05). The 5-year EFS and overall survival (OS) rates of the entire group were (84.5±2.2) % and (88.2±2.0) %, respectively. The 5-year OS rate of patients with TLS was significantly lower than that of those without TLS [ (80.8±4.6) % vs (91.0±2.0) %, P=0.01]. Among patients with TLS, those with serum uric acid of ≤612.7 μmol/L (n=36) exhibited lower 5-year EFS [ (67.8±8.1) % vs (87.5±5.2) %, P=0.04] and OS rates [ (69.9±8.1) % vs (90.0±4.7) %, P=0.04] compared with those with uric acid of >612.7 μmol/L (n=40). Similarly, patients with serum phosphate of ≤1.89 mmol/L (n=58) demonstrated lower 5-year EFS [ (71.6±6.0) % vs 100%, P=0.02] and OS rates [ (74.8±5.8) % vs 100%, P=0.03] compared with those with phosphate of >1.89 mmol/L (n=18) . Conclusions: TLS is associated with poor prognosis in patients with HG B-NHL. Patients with lower serum uric acid and phosphate levels during TLS demonstrated worse prognoses, indicating their potential value in predicting prognosis and guiding stratified treatment.
目的： 探讨肿瘤溶解综合征（TLS）对中高风险组儿童青少年高级别成熟B细胞非霍奇金淋巴瘤（HG B-NHL）患者预后的影响。 方法： 收集2010年1月至2022年12月中山大学肿瘤防治中心儿童肿瘤科收治的18岁以下的初治中高风险组HG B-NHL共283例患者的临床资料及预后情况。对患者的临床特征、发生TLS时的实验室指标及预后进行分析，实验室指标的最佳截断值使用R软件根据无事件生存（EFS）进行确定。 结果： 中位年龄7（1~18）岁，男女比例为3.6∶1。76例（26.9%）发生TLS，207例（73.1%）未发生TLS。与无TLS的患者相比，TLS患者的病理亚型为伯基特淋巴瘤、危险分层为高风险、年龄<12岁、LDH≥1 000 IU/L的比例均更高（均P<0.05）。全组患者的5年EFS率及总生存（OS）率分别为（84.5±2.2）%和（88.2±2.0）%。发生TLS患者的5年OS率低于未发生TLS的患者[（80.8±4.6）%对（91.0±2.0）%，P=0.01）]。发生TLS时，与血尿酸>612.7 μmol/L的患者（40例）相比，血尿酸≤612.7 μmol/L的患者（36例）5年EFS率[（67.8±8.1）%对（87.5±5.2）%，P=0.04]及OS率[（69.9±8.1）%对（90.0±4.7）%，P=0.04]较低；与血磷>1.89 mmol/L的患者（18例）相比，血磷≤1.89 mmol/L的患者（58例）5年EFS率[（71.6±6.0）%对100%，P=0.02]及OS率[（74.8±5.8）%对100%，P=0.03]较低。 结论： TLS与HG B-NHL患者的不良预后相关。发生TLS时血尿酸和血磷水平较低的患者预后更差，对预测患者预后及指导分层治疗具有一定价值。.
Keywords: Adolescent; B-cell lymphoma; Child; Prognosis; Tumor lysis syndrome.