影響多中心型淋巴瘤患犬在治療後長期存活之因子之回溯研究

Abstract

淋巴瘤是犬最常見的血液來源腫瘤，雖然大部分患犬對於治療有反應，但是僅有少數能達到長期存活。本研究目的為探討影響多中心型淋巴瘤患犬經治療後的總存活時間(OST)或疾病穩定間期(PFI)之臨床和病理學因子；其中總存活時間定義為發現淋巴結腫大到死亡的時間；疾病穩定間期為從治療後完全或部分緩解到疾病進展或因淋巴瘤死亡的時間。本研究共納入82隻確診為多中心型淋巴瘤且接受治療的患犬。單變因分析結果顯示B細胞淋巴瘤、接受單獨doxorubicin或是CHOP(cyclophosphamide、doxorubicin、vincristine和prednisolone)療程、療程中體重上升等因子的患犬有明顯較長的OST。此外，臨床亞期a、B細胞淋巴瘤、療程中出現白血球減少、達到腫瘤完全緩解、確診淋巴瘤時無貧血等因子的患犬有顯著較長的PFI。由多變因分析結果可知，臨床亞期a、B細胞淋巴瘤、治療中體重上升等因子的病犬有較長的總生存時間，但是具有非B和非T細胞淋巴瘤、只用類固醇治療、淋巴瘤診斷時有貧血等因子則有較短的PFI。除此之外，在CHOP療程組別與單純使用doxorubicin治療組別中OST或PFI較長的患犬，與前4次化療中出現完全或部分緩解、化療藥施打次數等因子有相關。總結來說，本篇研究顯示接受CHOP與DXR療程治療的狗有較好的預後，除此之外，臨床亞期a、B細胞淋巴瘤、腫瘤在施打化療藥的前4次有完全或是部分緩解、淋巴瘤診斷時無貧血、治療中有白血球低下、治療中體重上升等因子有較長的OST、PFI，與有較高的一年以上存活率，並且可將在存活時間長的病犬之臨床或病理因子運用於臨床上。

Lymphoma is the most common hematopoietic tumor in dogs; although most patients had response to the treatment, few of them could achieve longer survival after treatment. The aim of this study was to investigate the clinico-pathologic variables which have potential positive effects to overall survival time (OST), which defined as time from the lymphadenopathy first noted to death, and progression-free interval (PFI), which defined as the time from the identification of complete remission or partial remission until disease progression or lymphoma-associated death, in dogs with multicentric lymphomas after treatment. Eighty-two dogs that were diagnosed as multicentric lymphoma with treatments were enrolled. Univariate analysis revealed that dogs with B-cell phenotype, treated with single-agent doxorubicin or CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone), and body-weight gain during treatment had significantly longer OST. Furthermore, dogs with substage a, B-cell phenotype, leukopenia during treatment, complete response, and absence of anemia at diagnosis were associated with significantly longer PFI. By multivariate analysis, substage a, B-cell phenotype, and body-weight gain were the positive factors of longer OST; however, the factors of shorter PFI were non-B/non-T phenotype, single-agent prednisolone treatment and presence of anemia at diagnosis. Additionally, dogs with longer OST or PFI in the single-agent doxorubicin and CHOP treatment groups revealed significant association with complete response (CR) or partial response (PR) during first 4 times of chemotherapy and number of chemotherapy injection times by univariate and multivariate analyses. In conclusion, this study found that dogs administered with CHOP and DXR treatment had better prognosis; moreover, substage a, B-cell phenotype, CR or PR during first 4 times of chemotherapy, no anemia at diagnosis, leukopenia during treatment, and gaining weight during treatment were related to longer OST or PFI and associated to equal to or longer than one year OST. These prognostic factors of the dogs with longer survival would be useful in practice.