原发性中枢神经系统淋巴瘤临床特点与诊治策略  

Characteristics of diagnosis and treatment in 31 cases with primary central nervous system lymphomas

作　　者：李方明[1] 田增民[2] 聂青[1] 沈建良[3] 杨平[1] 张军[1] 贾海威[1] 朱奇[1] 郑伟[1] 方恒虎[1] 温居一[1] 王斌[1] 吴苏冬[1] 吴珊姗[1] 

机构地区：[1]海军总医院放射治疗科,北京100048 [2]海军总医院神经外科,北京100048 [3]海军总医院血液科,北京100048

出　　处：《海军总医院学报》2010年第2期78-82,共5页Journal of Naval General Hospital of PLA

摘　　要：目的探讨免疫正常的原发性中枢神经系统淋巴瘤(PCNSL)的生物学行为和临床特征,以帮助临床合理的诊断、治疗及对预后的判断。方法近9年经病理证实的31例PCNSL,其中27例为原发性脑淋巴瘤(PBL),4例为原发性眼淋巴瘤,回顾性分析其临床特征、诊断方法及治疗效果。在活检或手术后,患者主要以放、化疗综合治疗为主。化疗以环磷酰胺+阿霉素+长春新碱+泼尼松或甲氨喋呤+阿糖胞苷方案为主;全脑放疗40～44Gy,局部肿瘤缩野放疗加量11～25.4Gy。对眼部淋巴瘤放疗25.2～30Gy。结果 PCNSL患病率明显上升(增加了2.6倍)。全组患者均为免疫正常者。发病中位年龄57岁(14～83岁),PBL≥60岁占48.2%。脑多发病变者22例(81.5%)。脑立体定向活检确诊20例(1次性成功率90%),手术确诊11例。B细胞淋巴瘤占93.6%,T细胞淋巴瘤占6.4%。有4例患者在外院曾误诊65d至7个月。全组PBL1、3、5年生存率分别为68.2%、52.3%和35.0%。全组中位生存时间37个月。结论 PCNSL常发生在中老年人,B细胞来源为主。PBL临床和影像学很难与其他中枢神经系统肿瘤相区别,易误诊。对PBL疑似患者,脑立体定向活检可提高诊断效率。化、放疗综合治疗可提高疗效。≥60岁者预后不良。Objective To investigate the diagnosis and the most effective treatment for primary central nervous system lymphomas（PCNSL） in immunocompetent patients. Methods From Sep.1999 to Jul.2008,31 PCNSL patients were confirmed pathologicaly.The clinical characteristics,the differential diagnosis and treatments results were reviewed retrospectively.The patients received mainly both radiotherapy and chemotherapy after stereotactic brain biopsy or resection. Results Mobidity rate of PCNSL was rising in 6 years（2.6 times）.The age of the patients ranged from 14 to 83 years old （median age=57）,and 48.2% of them was more than 60 years old.Multiple lesions were reported in 22 cases（81.5%）.There were 20 patients received stereotactic brain biopsy.29 patients （93.6%） were B-cell lymphoma.The mediam survival time （MST）was 37 months.The overall 1-,3-and 5-year survival rates were 68.2%,52.3%and 35% in PBL,respectively. Conclusion PCNSL often occures in old-aged patients with multiple lesions.B-cell lymphoma is the main pathplogical sunstype.It is difficult to distinguish PBL from other CNS tumors only according to their clinical manifestations and radiological findings.PBL is easily misdiagnosis,and stereotactic brain biopsy can improve diagnosistic effeciency.The prognosis is poor in patients ≥60 yeas old.The combination of radiochemotherapy may improve the patient＇s survival.

关 键 词：中枢神经系统肿瘤 淋巴瘤 立体定向活检 化学治疗 放射治疗 

分 类 号：R733.4[医药卫生—肿瘤]