Abstract：
OBJECTIVE: The aim of this study is to identify risk factors contributing to central nervous system (CNS) invasion and to validate the suitability of the Central Nervous System International Prognostic Index (CNS-IPI) for individuals afflicted with diffuse large B-cell lymphoma (DLBCL).
METHODS: Based on the presence or absence of CNS invasion, 365 patients were stratified into two groups: the CNS group and the non-CNS group. The clinical data of the patients were retrospectively analyzed using univariate and multivariate analysis, and the differences in survival curves were compared. The dependent variable in this study was the presence or absence of CNS invasion, while the independent variables included age, stage, extranodal involvement, renal/adrenal involvement, and others. Statistical methods included the chi-squared test and Fisher\'s exact test for intergroup comparison and binary logistic regression for multi-factor analysis. The related risk factors were modeled using the Cox proportional hazards model. The Kaplan-Meier method was used to generate survival curves, and the log-rank test was used to compare the differences between survival curves. The optimal cutoff value of beta-2 (β2)-microglobulin was determined through the utilization of a receiver operating characteristic (ROC) curve. All P values were bidirectional, and P < 0.05 was considered statistically significant. Both SPSS 23.0 (IBM Inc., Armonk, NY, USA) and RStudio (R software version 4.0.2, R Project for Statistical Computing) software were used for data processing RESULTS: The five factors of the CNS-IPI were related to the prognosis of patients with CNS invasion. Bone involvement, albumin < 40 g/L, and P53 protein (+) were the risk factors for CNS invasion in patients with DLBCL. However, prognostic factors such as double strike, testicular involvement, breast involvement, uterine involvement, and bone marrow involvement did not apply to these patients. It was also discovered that elderly patients with DLBCL with reduced albumin levels were more susceptible to CNS invasion. Furthermore, extranodal involvement at multiple sites and elevated beta-2 (β2) microglobulin were independent prognostic factors CONCLUSION: Patients older than 60 years with DLBCL and decreased albumin are at increased risk for CNS invasion. In addition to the five factors in the CNS-IPI, bone involvement, albumin levels < 40 g/L, and P53 protein expression are risk factors affecting the prognosis of CNS invasion in patients with DLBCL.
METHODS: Based on the presence or absence of CNS invasion, 365 patients were stratified into two groups: the CNS group and the non-CNS group. The clinical data of the patients were retrospectively analyzed using univariate and multivariate analysis, and the differences in survival curves were compared. The dependent variable in this study was the presence or absence of CNS invasion, while the independent variables included age, stage, extranodal involvement, renal/adrenal involvement, and others. Statistical methods included the chi-squared test and Fisher\'s exact test for intergroup comparison and binary logistic regression for multi-factor analysis. The related risk factors were modeled using the Cox proportional hazards model. The Kaplan-Meier method was used to generate survival curves, and the log-rank test was used to compare the differences between survival curves. The optimal cutoff value of beta-2 (β2)-microglobulin was determined through the utilization of a receiver operating characteristic (ROC) curve. All P values were bidirectional, and P < 0.05 was considered statistically significant. Both SPSS 23.0 (IBM Inc., Armonk, NY, USA) and RStudio (R software version 4.0.2, R Project for Statistical Computing) software were used for data processing RESULTS: The five factors of the CNS-IPI were related to the prognosis of patients with CNS invasion. Bone involvement, albumin < 40 g/L, and P53 protein (+) were the risk factors for CNS invasion in patients with DLBCL. However, prognostic factors such as double strike, testicular involvement, breast involvement, uterine involvement, and bone marrow involvement did not apply to these patients. It was also discovered that elderly patients with DLBCL with reduced albumin levels were more susceptible to CNS invasion. Furthermore, extranodal involvement at multiple sites and elevated beta-2 (β2) microglobulin were independent prognostic factors CONCLUSION: Patients older than 60 years with DLBCL and decreased albumin are at increased risk for CNS invasion. In addition to the five factors in the CNS-IPI, bone involvement, albumin levels < 40 g/L, and P53 protein expression are risk factors affecting the prognosis of CNS invasion in patients with DLBCL.
摘要：
目的：这项研究的目的是确定导致中枢神经系统（CNS）侵袭的危险因素，并验证中枢神经系统国际预后指数（CNS-IPI）对患有弥漫性大B细胞淋巴瘤（DLBCL）的个体的适用性。
方法：根据是否存在中枢神经系统入侵，365名患者被分为两组：CNS组和非CNS组。采用单因素和多因素分析对患者的临床资料进行回顾性分析,并比较了存活曲线的差异。本研究中的因变量是是否存在中枢神经系统侵袭，而自变量包括年龄，舞台,结外受累,肾/肾上腺受累，和其他人。统计学方法包括卡方检验和Fisher精确检验进行组间比较，以及二元logistic回归进行多因素分析。采用Cox比例风险模型对相关危险因素进行建模。Kaplan-Meier方法用于生成存活曲线，采用对数秩检验比较存活曲线之间的差异。通过利用受试者工作特征（ROC）曲线确定β-2（β2）-微球蛋白的最佳截止值。所有P值都是双向的，P<0.05被认为具有统计学意义。两者都是SPSS23.0(IBMInc.，Armonk,NY,USA）和RStudio（R软件版本4.0.2，RProjectforStatisticalComputing）软件进行数据处理。结果：CNS-IPI的五个因素与CNS侵袭患者的预后相关。骨受累,白蛋白<40g/L，和P53蛋白（+）是DLBCL患者中枢神经系统侵袭的危险因素。然而,预后因素，如双重打击，睾丸受累,乳房受累，子宫受累,骨髓受累不适用于这些患者。还发现，白蛋白水平降低的DLBCL老年患者更容易受到CNS侵袭。此外，结外多部位受累和β-2(β2)微球蛋白升高是独立的预后因素。除了CNS-IPI中的五个因素外，骨受累,白蛋白水平<40g/L，P53蛋白表达是影响DLBCL患者中枢神经系统浸润预后的危险因素。
方法：根据是否存在中枢神经系统入侵，365名患者被分为两组：CNS组和非CNS组。采用单因素和多因素分析对患者的临床资料进行回顾性分析,并比较了存活曲线的差异。本研究中的因变量是是否存在中枢神经系统侵袭，而自变量包括年龄，舞台,结外受累,肾/肾上腺受累，和其他人。统计学方法包括卡方检验和Fisher精确检验进行组间比较，以及二元logistic回归进行多因素分析。采用Cox比例风险模型对相关危险因素进行建模。Kaplan-Meier方法用于生成存活曲线，采用对数秩检验比较存活曲线之间的差异。通过利用受试者工作特征（ROC）曲线确定β-2（β2）-微球蛋白的最佳截止值。所有P值都是双向的，P<0.05被认为具有统计学意义。两者都是SPSS23.0(IBMInc.，Armonk,NY,USA）和RStudio（R软件版本4.0.2，RProjectforStatisticalComputing）软件进行数据处理。结果：CNS-IPI的五个因素与CNS侵袭患者的预后相关。骨受累,白蛋白<40g/L，和P53蛋白（+）是DLBCL患者中枢神经系统侵袭的危险因素。然而,预后因素，如双重打击，睾丸受累,乳房受累，子宫受累,骨髓受累不适用于这些患者。还发现，白蛋白水平降低的DLBCL老年患者更容易受到CNS侵袭。此外，结外多部位受累和β-2(β2)微球蛋白升高是独立的预后因素。除了CNS-IPI中的五个因素外，骨受累,白蛋白水平<40g/L，P53蛋白表达是影响DLBCL患者中枢神经系统浸润预后的危险因素。
