Objective: To retrospectively analyze the clinical characteristics and prognosis of 85 newly diagnosed patients with follicular lymphoma (FL), as well as the prognostic value of comprehensive geriatric assessment (CGA) in patients with FL aged ≥ 60 years old. Methods: The clinical data and prognosis of 85 newly diagnosed FL patients admitted from August 2011 to June 2022 were collected. The clinical features, laboratory indicators, therapeutic efficacy, survival and prognostic factors of patients were statistically analyzed, and the prognosis of patients was stratified using various geriatric assessment tools. Results: ① The patients with FL were mostly middle-aged and older, with a median age of 59 (20-87) years, including 41 patients (48.2%) aged ≥60 years. The ratio of male to female was 1∶1.36. Overall, 77.6% of the patients were diagnosed with Ann Arbor stage Ⅲ-Ⅳ, and 17 cases (20.0%) were accompanied by B symptoms. Bone marrow involvement was the most common (34.1%). ②Overall, 71 patients received immunochemotherapy. The overall response rate was 86.6%, and the complete recovery rate was 47.1% of 68 evaluated patients. Disease progression or relapse in the first 2 years was observed in 23.9% of the patient. Overall, 14.1% of the patients died during follow-up. ③Of the 56 patients receiving R-CHOP-like therapies, the 3-year and 5-year progression-free survival (PFS) rates were 85.2% and 72.8%, respectively, and the 3-year and 5-year overall survival (OS) rates were 95.9% and 88.8%, respectively. The univariate analysis showed that age ≥60 years old (HR=3.430, 95% CI 1.256-9.371, P=0.016), B symptoms (HR=5.030, 95% CI 1.903-13.294, P=0.016), Prognostic Nutritional Index (PNI) <45.25 (HR=3.478, 95% CI 1.299-9.310, P=0.013), Follicular Lymphoma International Prognostic Index (FLIPI) high-risk (HR=2.918, 95% CI 1.074-7.928, P=0.036), and PRIMA-prognostic index (PRIMA-PI) high-risk (HR=2.745, 95% CI 1.057-7.129, P=0.038) significantly predicted PFS. Moreover, age ≥60 years old and B symptoms were independent risk factors for PFS. Progression of disease within 24 months (POD24) significantly predicted OS in the univariate analysis. Conclusions: FL is more common among middle-aged and older women. Age, B symptoms, PNI score, FLIPI high-risk, PRIMA-PI high-risk, and POD24 influenced PFS and OS. The CGA can be used for treatment selection and risk prognostication in older patients with FL.
目的： 探讨初治滤泡淋巴瘤（FL）患者的临床特征与预后，以及老年综合评估（comprehensive geriatric assessment，CGA）对国内年龄≥60岁FL患者的预后价值。 方法： 收集2011年8月至2022年6月北京医院血液科收治的85例初诊FL患者临床资料及预后情况。统计分析患者临床特征、实验室指标、治疗疗效、生存及预后因素，使用多种老年评估工具对患者预后分层。 结果： ①FL患者多为中老年起病，中位发病年龄59（20~87）岁，其中年龄≥60岁者41例（48.2%），男女比例为1∶1.36。77.6%的患者诊断时Ann Arbor分期为Ⅲ~Ⅳ期，伴有B症状17例（20.0%），骨髓侵犯最常见（34.1%）。②71例患者接受一线系统化疗和（或）免疫治疗，可评估疗效的68例患者中总缓解率为86.8%，完全缓解率为47.1%。其中17例（23.9%）患者在治疗2年内病情进展或复发，共计10例（14.1%）患者死亡。③R-CHOP治疗组生存分析示：中位随访52.9（10.2~138.8）个月，3年无进展生存（PFS）率及总生存（OS）率分别为85.2%和95.9%，5年PFS率及OS率为72.8%和88.8%。单因素分析年龄≥60岁（HR=3.430，95%CI 1.256~9.371，P=0.016）、B症状（HR=5.030，95%CI 1.903~13.294，P=0.001）、预后营养指数（PNI）<45.25（HR=3.478，95%CI 1.299~9.310，P=0.013）、FL国际预后指数（FLIPI）高危（HR=2.918，95%CI 1.074~7.928，P=0.036）、PRIMA预后指数（PRIMA-PI）高危（HR=2.745，95%CI 1.057~7.129，P=0.038）是PFS的不良预后因素。POD24（HR=9.160，95%CI 1.202~69.830，P=0.033）是OS的不良预后因素。多因素分析中年龄≥60岁（HR=3.002，95%CI 1.014~8.889，P=0.047），B症状（HR=3.810，95%CI 1.052~13.801，P=0.042）能独立预测PFS，未发现影响OS的独立预测因素。 结论： FL多为中老年女性患者。年龄、B症状、PNI、FLIPI、PRIMA-PI、POD24是影响FL患者PFS和OS的重要因素。CGA对预测老年FL预后及指导治疗均可能具有一定价值。.
Keywords: Comprehensive geriatric assessment; Lymphoma, Follicular; Survival analysis.