原发性中枢神经系统淋巴瘤23例临床分析  

The clinical analysis of primary central nervous system lymphoma in 23 patients

作　　者：朴颖哲[1] 李鹏[1] 刘群[1] 李文良[1] 

机构地区：[1]天津医科大学肿瘤医院脑系肿瘤科,300060

出　　处：《中华内科杂志》2011年第11期954-957,共4页Chinese Journal of Internal Medicine

摘　　要：目的探讨原发性中枢神经系统淋巴瘤（PCNSL）的诊断、合理治疗方案和预后的相关因素。方法收集天津医科大学肿瘤医院2005年1月至2007年12月经病理证实且随访资料完整的23例免疫功能正常的PCNSL患者，其中男10例，女13例，中位年龄50岁。行腰穿检查者18例，检查出瘤细胞者4例。8例行开颅手术切除，15例行立体定向活检术。4例行全颅放疗，6例行以大剂量甲氨蝶呤为基础的联合化疗，13例行放疗联合化疗。分析其治疗、临床特点与预后之间的联系。结果Kaplan—Meier分析显示本系列患者中位生存期45．0个月，3年生存率56．5％。Log—Rank检验发现放疗联合化疗组（43．8和30．0个月）与化疗组（39．7和29．7个月）的总生存期及肿瘤无进展生存期明显长于单纯放疗组（25．7和19．8个月，P值均〈0．05）；放疗联合化疗组的总生存期长于单纯化疗组（P〈0．05），2组间肿瘤无进展生存期无明显差异（P〉0．05）。结论病理诊断仍是确诊的金标准，脑脊液检查发现瘤细胞者也可确诊。以全颅放疗联合化疗为主的综合治疗优于单纯放疗或化疗。Objective To explore the clinical characteristics and the relationship between rational therapy and prognosis in primary central nervous system lymphoma （PCNSL）. Methods Clinical data of 23 patients pathologically confirmed as PCNSL and treated in our hospital from January 2005 to December 2007 were collected and analyzed retrospectively. SPSS 13.0 statistical analysis software was used to analyze the correlation between therapy, clinical characteristics and prognosis. Among the 23 patient, 10 were male and 13 were female, with a median age of 50 （2-75） years old. Eighteen patients were undertaken lumbar puncture, and tumor cells in cerebral spinal fluid （CSF） was found in 4 patients. Tumorectomy was performed in 8 patient~ while 15 patients biopsy. Among them, 4 accepted whole brain irradiation, 6 accepted associated chemotherapy based on a high-dose of methotrexate （MTX） and 13 accepted radiotherapy combined with chemotherapy. Results Kaplan-Meier analysis showed that in this serial patients, the median survival time was 45.0 months and the 3-year survival rate was 56. 5%. Log-Rank test revealed that the whole survival time and the non-progression survival time of radiotherapy combined with chemotherapy （43.8 and 30. 0 months, respectively） and high-dose MTX chemotherapy （ 39.7 and 29. 7 months, respectively） were much longer than those of radiotherapy alone （25.7 and 19.8 months, respectively, all P 〈 0.05 ） . Log-Rank test showed no significant difference between high-dose MTX chemotherapy alone and radiotherapy combined with chemotherapy （ P 〉 0. 05 ）, but the whole survival time was much shorter in high-dose MTX chemotherapy （P 〈 0. 05）. Conclusions The detection of tumor cells in CSF can confirm the diagnosis, but pathological biopsy is the gold standard. The efficacy of associated chemotherapy based on a high-dose of MTX combined with radiotherapy is much better than radiotherapy or chemotherapy alone.

关 键 词：淋巴瘤 中枢神经系统 病理学 预后 

分 类 号：R739.4[医药卫生—肿瘤]