目的

探讨获得性免疫缺陷综合征相关淋巴瘤（ARL）的临床特征及预后的变化趋势。

方法

以2006年1月至2015年12月于武汉大学中南医院诊治的53例ARL患者为对照组，2016年开始本院ARL患者抗肿瘤方案有所改进，故以2016年1月至2022年12月于本院诊治的97例ARL患者为研究组；采用Pearson卡方检验或Fisher's确切概率法比较两组患者的临床特征［非霍奇金淋巴瘤（NHL）病理分型、Ann Arbor分期、中枢侵犯和骨髓侵犯等］及生存状态。

结果

与对照组相比，研究组患者确诊ARL时平均年龄大［（48.81 ± 12.50）岁 vs. （43.13 ± 12.75）岁：t = 2.65、P = 0.010］，临床分期为Ⅲ～Ⅳ期者占比高（81.44% vs. 54.72%：χ² = 13.722、P ＜ 0.001），国际预后指数（IPI）评分差（3～5分比例：84.53% vs. 66.04%：χ² = 7.495、P = 0.024），骨髓受侵犯者占比高（46.39% vs. 28.30%：χ² = 4.673、P = 0.031），淋巴瘤病理分型变化显著（P = 0.003）［伯基特淋巴瘤（BL）患者占比显著升高（37.11% vs. 9.43%），弥漫大B细胞淋巴瘤占比降低（44.33% vs. 67.92%）］；而两组患者的性别、CD4⁺ T细胞计数、是否中枢侵犯、是否接受ARL治疗和高效抗反转录病毒治疗（HAART）等差异均无统计学意义（P均＞ 0.05）。随访期间共93例（研究组55例，对照组38例）ARL患者死亡，随访时间为11.21（4.00，29.25）个月。研究组和对照组患者随访时间分别为10.0（4.50，24.50）个月和7.0（2.0，112.0）个月（Z = 0.11、P = 0.910），1年总生存（OS）率分别为54.64%和41.51%（χ² = 2.363、P = 0.124），其中接受抗肿瘤治疗患者的1年OS率分别为69.33%和60.0%（χ² = 0.931、P = 0.335），未接受肿瘤治疗患者的1年OS率分别为4.55%和5.56%（P ＞ 0.999），差异均无统计学意义。肿瘤进展是导致研究组和对照组患者死亡主要原因，分别高达81.82%（45/55）和81.58%（31/38）。

结论

近年ARL患者发病年龄推迟，BL占比较前明显增多，ARL临床分期分级更差，探索更为有效的治疗方法更加迫切。

Objective

To investigate the clinical features and prognostic trends of acquired immunodeficiency syndrome （AIDS）-related lymphoma （ARL）.

Methods

Total of 53 patients with ARL diagnosed and treated in Zhongnan Hospital of Wuhan University from January 2006 to December 2015 were selected as control group， due to the improvement of the anti-tumor regimen for ARL patients since 2016，97 patients with ARL diagnosed and treated in our hospital from January 2016 to December 2022 were selected as research group. Pearson Chi-square test or Fisher’s exact probability method were used to compare the clinical characteristics， including non-Hodgkin lymphoma （NHL） pathological classification， Ann Arbor stage， central involvement and bone marrow involvement， etc， and survival status between the two groups.

Results

Compared with control group， patients in research group were older ［（48.81 ± 12.50） years old vs. （43.13 ±12.75） years old：t = 2.65， P = 0.010］， and the proportion of patients with clinical stage Ⅲ-Ⅳ was higher （81.44%vs. 54.72%：χ² = 13.722， P ＜ 0.001）， international prognostic index （IPI） score was poorer （proportion of 3-5 points：84.53% vs. 66.04%：χ² = 7.495， P = 0.024）， proportion of bone marrow involvement was higher （46.39%vs. 28.30%：χ² = 4.673， P = 0.031） and the pathological classification of lymphoma changed significantly （P = 0.003）［the proportion of Burkitt lymphoma （BL） patients increased significantly （37.11% vs. 9.43%）， the proportion of diffuse large B-cell lymphoma decreased （44.33% vs. 67.92%）］； There were no significant differences in gender， CD4⁺ T cell count， central nervous system involvement， ARL treatment and highly active antiretroviral therapy （HAART） between the two groups （all P ＞ 0.05）. Total of 93 ARL patients （55 cases in research group and 38 cases in control group） died during the follow-up period， and the follow-up time was 11.21（4.00， 29.25） months. The follow-up time of research group and control group were 10.0 （4.50， 24.50） months and 7.0 （2.0， 112.0） months， respectively （Z = 0.11， P = 0.910）. The one-year overall survival （OS） rates of research group and control group were 54.64% and 41.51%， respectively （χ² = 2.363， P = 0.124）. The oneyear OS rates of patients who received oncotherapy were 69.33% and 60.0% （χ² = 0.931， P = 0.335）， and the one-year OS rates of patients who did not receive oncotherapy were 4.55% and 5.56% （P ＞ 0.999）， all without significant differences. Tumor progression was the main cause of death in research group and control group，up to 81.82% （45/55） and 81.58% （31/38）， respectively.

Conclusions

In recent years， the onset age of ARL patients is delayed， the proportion of BL is significantly increased， the clinical stage of ARL is worse， and it is more urgent to explore more effective treatment methods.