儿童非霍奇金淋巴瘤单中心临床研究  

A single-center clinical analysis of children with non-Hodgkin＇ s lymphoma

作　　者：邵静波[1] 蒋慧[1] 陆正华[1] 杨静薇[1] 李红[1] 张娜[1] 杨为群[1] 廖雪莲[1] 

机构地区：[1]上海市儿童医院,上海交通大学附属儿童医院血液肿瘤科,200040

出　　处：《中华实用儿科临床杂志》2013年第15期1146-1149,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：上海市卫生局青年科研项目（20114y068）

摘　　要：目的探讨儿童非霍奇金淋巴瘤（NHL）的临床特征与治疗效果。方法2000年1月至2012年10月在上海市儿童医院，上海交通大学附属儿童医院确诊的初发NHL患儿45例，按照WHO淋巴瘤分型标准诊断；按不同免疫标记、病理分型及肿瘤分期予以化疗方案；采用Kaplan—Meier法计算分析总生存率（0s）和无事件生存率（EFS）。结果45例患儿进入统计，男37例，女8例；年龄（6．73±3．12）岁。其中B细胞淋巴瘤（B—NHL）26例，T细胞淋巴瘤（T—NHL）19例。根据St．Jude分期系统，Ⅱ期6例，Ⅲ期21例，Ⅳ期18例。B．NHL原发于腹腔14例，T—NHL原发于腹腔1例，差异有统计学意义（P=0．008）。T-NHL原发于纵隔8例，B．NHL原发于纵隔2例，差异有统计学意义（P=0．047）。43例（95．56％）患儿治疗后获得缓解（完全缓解＋部分缓解），2例未缓解，其中1例Ⅲ期，1例Ⅳ期。随访至2013年3月30日，36例（80．00％）获得持续缓解（CCR），随访时间5—156个月，平均随访时间48个月。3例分别在原发部位及颈部复发（Ⅲ期2例，Ⅳ期1例），复发时间为4、9、24个月。预计5年0s及EFS分别为（78．4±6．4）％、（71．3±7．5）％。23／26例（88．46％）B—NHL患儿获得CCR，13／19例（68．42％）T—NHL患儿获得CCR。B—NI-IL和T-NHL2组患儿预计5年OS分别为（86．7±7．2）％和（68．0±10．8）％；预计5年EFS分别为（79．5±9．6）％和（60．5±12．0）％，2组比较差异无统计学意义（P=0．436，0．323）。单因素分析提示临床分期影响预后（P=0．024）。结论儿童B—NHL原发部位多见于腹腔，T—NHL原发部位多见于纵隔。儿童B—NHL相对于T—NHL，能达到较快缓解，取得较好预后。儿童T—NHL就诊时较B-NHL年龄偏大，且以晚期居多（Ⅲ期＋Ⅳ期），导致其预后不良。Objective To explore the clinical features and efficacy for childhood non-Hodgkin＇s lymphoma （NHL）. Methods From Jan. 2000 to Oct. 2012,45 children newly diagnosed with NHL were included in the study ac- cording to the World Health Organization classification of tumors. The chemotherapy regimens were based on immune phenotype, pathological type and clinical stages. The rate of overall survival （OS） and event-free survival （EFS） were generated by Kaplan-Meier. Results There were 45 children in total, 37 male and 10 female. The average age was （6. 73 ±3.12） years. Among 45 cases,26 cases were B cell NHL（B-NHL） and 19 cases were T cell NHL（T-NHL）. According to St. Jude staging classification,6 of 45 cases were divided into stage 11,21 cases into stage m and 18 cases into stage IV. Fourteen cases of primary abdominal B-NHL compared with 1 case of T-NHL, which had a significant difference （P = 0.008）. Eight cases of primary mediastinal T-NHL compared with 2 cases of B-NHL, which also had a significant difference（ P = 0. 047 ）. Forty-three of 45 cases of NHL reached complete remission（CR） and partial remission（PR） （95.56%） ,while 1 case of stage BI and 1 case of stage IV never reached CR. To the 30＇h, Mar. 2013,36 of 45 cases（ 80.00% ） were continued complete remission（CCR） with 5 to 156 months follow up, averaging 48 months. Three cases relapsed at original place and cervical part（2 cases of stage 111 and 1 case of stage IV ） which occurred in 4,9 or 24 months. The Kaplan-Meier estimates of 5-year OS and EFS were （78.4 ± 6.4 ）% and （71.3 ± 7.5 ）%. Twenty-three of 26 cases of B-NHL in kept in CCR（88.46% ）. Thirteen of 19 cases of T-NHL were kept in CCR （68.42%）. The estimated 5-year OS of B-NHL and T-NHL were（86.7 ±7.2）% and（68.0 ±10.8）% ,and the EFS were （79.5 ±9.6 ） % and （ 60.5 ±12.0 ） % （ P = 0. 436,0. 323 ）. Clinical stage was the major prognostic factor influencing survival（ P = 0. 024）. Conclusions The orig

关 键 词：非霍杰金淋巴瘤 B淋巴细胞 T淋巴细胞 儿童 

分 类 号：R733.1[医药卫生—肿瘤]