原发性中枢神经系统淋巴瘤的临床特征分析  

Clinical features analysis on primary central nervous system lymphoma

作　　者：韩天洁[1] 陈波斌[1] 许小平[1] 陈宇[1] 姬美容[1] 林果为[1] 

机构地区：[1]复旦大学附属华山医院血液科,上海200040

出　　处：《白血病．淋巴瘤》2011年第10期597-601,共5页Journal of Leukemia & Lymphoma

基　　金：上海市卫生局科研基金（2008064）;上海市自然科学基金（10ZR1405200）;国家科技部“国家科技重大新药创制”专项基金（2008ZX09312-010）

摘　　要：目的分析原发性中枢神经系统淋巴瘤（PCNSL）的临床特征，探讨影响疾病的预后因素，并对不同的治疗方案进行评价。方法回顾性分析初发PCNSL患者的临床资料、治疗经过及随访结果，应用Log—rank进行单因素分析，应用COX回归模型进行生存资料的多因素分析。结果共收集PCNSL初发病例64例，中位年龄54．9岁，男性多于女性，肿瘤单发62％（40／64），深部病变占54％（33／61）。在我科诊治的具有完整治疗资料的患者26例，其中19例患者初始治疗为单纯化疗，6例为全颅放疗（WBRT）后1个月进行化疗，1例患者初治时仅行WBRT。中位生存时间为17个月，血红蛋白≥9g／L患者的生存时间长于血红蛋白〈9g／L患者。年龄〉60岁、性别、体能状态、病变部位等因素对预后无明显影响。应用含大剂量甲氨蝶呤（HD—MTX）或替尼泊苷的方案化疗者的预后优于未使用者，化疗联合放疗可能有助于改善患者的预后（X2=3．24，P=0．07），应用CHOP方案（环磷酰胺、多柔比星、长春新碱、泼尼松）、利妥昔单抗、鞘内注射化疗药物等与预后关系不大；多因素分析提示HD—MTX是影响PCNSL患者生存时间的独立有利因素，颅内病灶部位、病灶的多少、是否联合放化疗等均不是影响预后的独立因素。结论PCNSL预后较差，应用HD—MTX、替尼泊苷等药物可改善患者的预后，贫血尤其中重度贫血患者预后不良。Objective To investigate the clinical features of patients with primary central nervous system lymphoma （PCNSL）, to analyze and evaluate relevant prognostic factors and therapeutic regimens. Methods The retrospective study was conducted on 64 cases with PCNSL. The Log-rank test was applied to univariate analyses, whereas Cox regression was used in multivariate analyses on pertinent data of survival. Results The retrospective study was done on 64 newly diagnosed PCNSL cases. The median age was 54.9 years old, and the overall male/female ratio was 〉1. Most of tumors （40/64） presented solely; 54 % （33/61） of all tumors were associated to deep lesions. Twenty-six patients with integrate analyzable data were diagnosed and treated at our hospital, among which, 19 patients received chemotherapy alone; 1 patient received WBRT alone, and 6 received WBRT first, and chemotherapy one month later. The median survival time of all patients was 17 months. Statistically significant predictors shown in the univariate analyses were anemia degree and the use of HD-MTX and teniposide. Moderate to severe anemia alone was a significant predictor of bad prognosis, whereas chemotherapeutic regimens without HD-MTX and teniposide also showed bad prognosis. A combination of radiotherapy and chemotherapy had substantially improved their prognosis （ X2 =3.24, P =0.07）. Age, gender, physical status and tumor location had not statistically significant on prognosis; CHOP regimen, rituximab, intrathecal injection of chemotherapeutic drug had non-significant impact on prognosis and survival. Cox-regression analysis for multivariate analyses on survival data showed the HD-MTX treatment was independent favorable predictor of prognosis; however, location and numbers of intracranial lesions, combination of radio and chemotherapy did not have independent prognostic impact on prognosis. Conclusion Prognosis of patients with PCNSL is extremely poor; HD-MTX or teniposide improve the prognosis and survival of patients. Prognosis of patien

关 键 词：中枢神经系统肿瘤 淋巴瘤 非霍奇金 临床特征 预后 

分 类 号：R739.4[医药卫生—肿瘤]