No studies have focused on the trajectory of the average relative dose intensity (ARDI) during cycles of first-line chemotherapy for patients with diffuse large B-cell lymphoma. To evaluate the impact of attenuating ARDI during cycles on overall survival, we conducted a multi-centre, longitudinal, observational retrospective study. A total of 307 analysable patients were enrolled. Multivariate Cox hazards modelling with restricted cubic spline models revealed prognostic benefits of higher ARDI up to, but not after, cycle 6. According to group-based trajectory modelling, patients were classified into five groups depending on the pattern of ARDI changes. Among these, two groups in which ARDI had fallen significantly to less than 50% by cycles 4–6 displayed significantly poorer prognosis, despite increased ARDI in the second half of the treatment period (log-rankp= 0.02). The Geriatric Nutritional Risk Index offered significant prediction of unfavourable ARDI changes (odds ratio 2.540, 95% confidence interval 1.020–6.310;p= 0.044). Up to cycle 6, maintenance of ARDI in all cycles (but particularly in the early cycles) is important for prognosis. Malnutrition is a significant factor that lets patients trace patterns of ARDI changes during cycles of chemotherapy associated with untoward prognosis.
目前尚无研究关注弥漫性大B细胞淋巴瘤患者一线化疗周期中平均相对剂量强度（ARDI）的动态变化轨迹。为评估化疗周期内ARDI衰减对总生存期的影响，我们开展了一项多中心、纵向、观察性回顾研究。共纳入307例可分析患者。采用限制性立方样条模型的多变量Cox风险模型分析显示，在治疗第6周期前（而非之后）维持较高ARDI水平具有预后获益。基于群体轨迹模型分析，根据ARDI变化模式将患者分为五组。其中两组患者在4-6周期时ARDI显著下降至50%以下，尽管治疗后期ARDI有所回升，仍表现出显著较差的预后（时序检验p=0.02）。老年营养风险指数对不良ARDI变化模式具有显著预测价值（比值比2.540，95%置信区间1.020-6.310；p=0.044）。研究结果表明：直至第6周期前，维持所有周期（特别是早期周期）的ARDI对预后至关重要。营养不良是导致患者在化疗周期中出现不良预后相关ARDI变化轨迹模式的重要因素。
肿瘤(癌症)患者之家