原发肠道弥漫大B细胞淋巴瘤临床病理特征及预后分析  

Clinicopathological characteristics and prognostic analysis of primary intestinal diffuse large B-cell lymphoma

作　　者：黄昱[1] 周生余[1] 何小慧[1] 桂琳[1] 杨建良[1] 刘鹏[1] 秦燕[1] 张长弓[1] 邢镨元[1] 杨晟[1] 汪麟[1] 周立强[1] 董梅[1] 孙燕[1] 石远凯[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院内科抗肿瘤分子靶向药物临床研究北京市重点实验室,100021

出　　处：《中华医学杂志》2015年第48期3895-3898,共4页National Medical Journal of China

基　　金：国家科技支撑计划（2014BA109812）;国家科技重大专项（2012ZX09303012）

摘　　要：目的 探讨原发肠道弥漫大B细胞淋巴瘤的临床病理特征、治疗方案及预后因素.方法 回顾性分析2003年8月至2012年11月中国医学科学院肿瘤医院收治的54例原发肠道弥漫大B细胞淋巴瘤患者的临床资料,并进行预后相关因素分析.结果 54例患者中男43例,女11例,男女比例3.91∶1,中位发病年龄为49（7 ～76）岁,胃肠道淋巴瘤Lugano分期以Ⅰ～Ⅱ期为主（占64.8％）.50例患者获得随访,中位随访49（1～118）个月,1、3和5年总生存率分别为82.0％、69.9％和60.7％.1、3和5年无进展生存率分别为68.0％、58.0％和53.4％.单因素分析显示影响预后的因素包括临床分期、B症状、国际预后指数（IPI）评分、乳酸脱氢酶水平、β2-微球蛋白水平、病变大小及治疗方案（均P ＜0.05）.手术治疗联合化、放疗与单纯手术或化疗5年总生存率分别为67.1％和40.0％ （P ＜0.05）,联合利妥昔单抗化疗组5年生存率显著高于未联合利妥昔单抗化疗组（71.2％比47.6％,P＜0.05）.多因素分析显示,病变大小（RR=7.686,P=0.022）和乳酸脱氢酶水平（RR=10.131,P=0.017）为影响患者总生存的独立预后因素.结论 原发肠道弥漫大B细胞淋巴瘤是一类异质性较强的疾病,手术联合化放疗及使用利妥昔单抗治疗可能有助于改善总体预后.Objective To analyze the clinicopathological characteristics,treatment protocls and prognostic factors in patients with primary intestinal diffuse large B-cell lymphoma （DLBCL）.Methods The clinical data of 54 patients with DLBCL who were treated in Cancer Hospital of Chinese Academy of Medical Sciences in the period from August 2003 to November 2012 were retrospectively analyzed,and the relevant prognostic factors of DLBCL were analyzed.Results Of the 54 patients,there were 43 males and 11 females （male∶ female ratio was 3.91∶1）,with a median age of onset of 49 （7-76） years.Most patients （64.8%） were in Lugano stage Ⅰ-Ⅱ.Of all the patients,50 were followed up for a median of 49 （1-118） months.The 1-,3-and 5-year overall survival （OS） rates were 82.0%,69.9% and 60.7%,respectively;the 1-,3-and 5-year progression-free survival （PFS） rates were 68.0%,58.0% and 53.4%,respectively.Univariate analysis showed that the factors affecting prognosis of DLBCL patients included Lugano stage,B symptom,International Prognostic Index （IPI） score,lactate dehydrogenase level,β2-microglobulin level,tumor size,and treatment protocols （all P 〈 0.05）.The 5-year OS rate was 67.1% in the patients treated with surgery plus chemoradiotherapy,and 40.0% in those treated with surgery or chemotherapy alone（P 〈0.05）.In the patients treated with chemotherapy combined with rituximab,the 5-year OS rate was higher than in those treated with chemotherapy alone （71.2% vs 47.6%,P 〈 0.05）.Multivariate analysis indicated that tumor size （RR =7.686,P =0.022） and lactate dehydrogenase level （RR =10.131,P =0.017） were independent prognostic risk factors affecting OS.Conclusions Primary intestinal DLBCL is a highly heterogeneous malignancy.Surgery combined with chemoradiotherapy and rituximab may help improve the overall prognosis of DLBCL patients.

关 键 词：淋巴瘤 大B-细胞 弥漫性 肠 临床特征 预后 治疗 

分 类 号：R735.3[医药卫生—肿瘤]