结节性淋巴细胞为主型霍奇金淋巴瘤34例临床分析  

Clinical analysis of 34 patients with nodular lymphocyte predominant Hodgkin lymphoma

作　　者：王翔[1] 陶云霞[1] 张有为[1] 孙三元[1] 

机构地区：[1]徐州市中心医院肿瘤内科,徐州221009

出　　处：《山西医科大学学报》2015年第11期1117-1121,共5页Journal of Shanxi Medical University

摘　　要：目的了解结节性淋巴细胞为主型霍奇金淋巴瘤（NLPHL）的临床病理特征、治疗方法和疗效,并探讨影响预后因素。方法回顾性分析我院1999-01~2010-07初治的34例NLPHL患者临床病理资料、治疗方法和随访资料,采用KaplanMeier法计算生存率,并以Log-rank法进行组间差异的检验,以Cox比例风险模型进行多因素分析。结果全组男性22例（64.7%）,女性12例（35.3%）。全组中位年龄为29岁（4-69岁）。按照Ann Arbor-Cotswolds分期系统,Ⅰ期9例（26.5%）,Ⅱ期15例（44.1%）,Ⅲ期7例（20.6%）,Ⅳ期3例（8.8%）,合并B症状10例（29.4%）,大纵隔1例（2.9%）。外周血淋巴细胞/单核细胞≥2.1者27例（81.8%,27/33）,血清乳酸脱氢酶（LDH）升高8例（23.5%）,血清β2微球蛋白升高13例（38.2%）。单纯化疗6例（17.6%）,单纯放疗6例（17.6%）,综合治疗22例（64.7%）。全组患者治疗后完全缓解29例（85.3%）,部分缓解4例（11.8%）,进展1例（2.9%）。中位随访100月,复发10例,死亡6例,5年和10年的无进展生存率为73.5%和67.6%,5年和10年的总生存率均为82.4%。单因素分析示血清β2微球蛋白升高,分期晚（Ⅲ/Ⅳ）是影响无进展生存及总生存的不良预后因素,外周血淋巴细胞/单核细胞〈2.1是总生存的不良预后因素。多因素分析显示,分期是影响无进展生存的独立预后因素,淋巴细胞/单核细胞比例是影响总生存的独立预后因素。结论 NLPHL的预后好,但晚期及外周血淋巴细胞/单核细胞〈2.1患者的预后较差。Objective To investigate the clinicopathological charactersties,effective treatment,survival and prognostic factors of patients with nodular lymphocyte predominant Hodgkin lymphoma（ NLPHL）. Methods A total of 34 patients with NLPHL were treated from January 1999 to July 2010. The clinicopathological features and follow-up data of the patients were retrospectively reviewed. The survival rate was calculated by Kaplan-Meier method and compared by Log-rank test. COX multivariate prognosis analysis was performed. Results There were 22 males（ 64. 7%） and 12 females（ 35. 3%） in the study,with the median age of 29 years（ range： 4-69 years）. According to Ann Arbor-Cotswolds system,there were 9 cases（ 26. 5%） of stage Ⅰ,15 cases（ 44. 1%） of stage Ⅱ,7 cases（ 20. 6%） of stage Ⅲ,and 3 cases（ 8. 8%） of stage Ⅳ. Ten patients（ 29. 4%） had B symptoms and 1 patient（ 2. 9%） had mediastinal mass. Peripheral blood absolute lymphocyte count / monocyte ratio≥2. 1 was found in 27 patients（ 81. 8%,27 /33）,the elevated serum lactate dehydrogenase in 8 patients（ 23. 5%）,and the elevated serum β2-microglobulin in 13 patients（ 38. 2%）. Six patients underwent radiotherapy alone,6 received chemotherapy alone,and 22 patients received chemotherapy combined with radiotherapy. After treatment,29 cases（ 85. 3%） attained complete remission,4 cases（ 11. 8%） achieved partial remission and 1 case（ 2. 9%） experienced disease progression. During a median follow-up period of 100 months,ten patients experienced disease relapse and 6 patients died. The 5- and 10-year progression-free survival（ PFS） rates were 73. 5% and 67. 6%,and the 5-and 10-year overall survival（ OS）rates were both 82. 4%. Univariate analysis showed that the advanced stage and the elevated serum β2-microglobulin were related to poor PFS and OS. Peripheral blood absolute lymphocyte count / monocyte ratio 2. 1 was related to poor OS. Multivariate analysis showed that the advanced stage as an independent u

关 键 词：霍奇金淋巴瘤 生存率 预后 

分 类 号：R733.1[医药卫生—肿瘤]