40例原发性骨淋巴瘤的预后分析及分期探讨  

Prognosis and staging of primary bone lymphoma：an analysis of 40 patients

作　　者：曾静[1] 曲芃芃[1] 庞青松[2] 王佩国[2] 章文成[2] 王凤明[2] 张会来[3] 

机构地区：[1]天津市中心妇产科医院妇瘤科,300100 [2]国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室天津医科大学肿瘤医院放疗科,天津300060 [3]国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室天津医科大学肿瘤医院淋巴瘤科,天津300060

出　　处：《中华放射肿瘤学杂志》2016年第8期843-846,共4页Chinese Journal of Radiation Oncology

摘　　要：目的：回顾分析原发性骨淋巴瘤（ PBL）患者疗效和预后因素。方法1964—2014年本中心收治PBL患者40例，其中单纯化疗10例、放化疗10例、术后化疗10例、术后放化疗9例、单纯手术1例。放疗剂量中位数36 Gy。采用Kaplan？Meier法计算生存率并Logrank法检验和单因素分析。结果随访率为100％，3年样本数36例。全组1、3年OS率分别为60％、42％，1、3年PFS率分别为45％、34％。单因素分析显示确诊时无病理性骨折、LDH正常、国际预后指数评分≤1分、临床分期较早（ⅠE 期）、首次治疗疗效达CR、化疗周期≥6周、放疗剂量≥40 Gy、放疗后照射野外无进展、治疗过程中骨髓抑制＜3级为预后影响因素（ P＝0.027、0.037、0.000、0.016、0.000、0.000、0.022、0.014、0.030）。结论 PBL发病率较低，通过综合治疗取得了一定疗效。 Ann Arbor作为PBL分期系统有一定局限性，应根据局部骨破坏范围及转移情况探讨更适合此类患者的分期。Objective To retrospectively analyze the treatment outcomes and prognostic factors for primary bone lymphomas （ PBL） . Methods Forty patients with PBL who were admitted to our center from 1964 to 2014 were enrolled as subjects. In those patients, 10 were treated with chemotherapy alone, 10 with radiochemotherapy, 10 with postoperative chemotherapy, 9 with postoperative radiochemotherapy, and 1 with surgery alone. The median radiation dose was 36 Gy. The Kaplan-Meier method was used to calculate survival rates . The log-rank test was used for survival difference analysis and univariate prognostic analysis . Results The follow-up rate was 100%. The 3-year sample size was 36. In all patients, the 1-and 3-year overall survival rates were 60% and 42%, respectively, while the 1-and 3-year disease-free survival rates were 45%and 34%, respectively. The univariate analysis showed that no pathological fracture at diagnosis, normal lactate dehydrogenase level, an International Prognostic Index score of ≤1, early clinical stage （ stageⅠE ） , complete response after initial treatment, no less than 6 cycles of chemotherapy, a radiation dose of≥40 Gy, no progression outside radiation field after radiotherapy, and grade〈3 bone marrow suppression during the treatment were prognostic factors for survival （ P=0. 027, 0. 037, 0. 000, 0. 016, 0. 000, 0. 000, 0. 022, 0. 014, and 0. 030）. Conclusions The incidence of PBL is low. Comprehensive treatment can achieve satisfactory outcomes. As a PBL staging system, Ann Arbor has limitations. The staging of PBL should be based on local bone destruction and metastasis.

关 键 词：淋巴瘤 骨/放射疗法 淋巴瘤 骨/化学疗法 淋巴瘤 骨/放化疗法 预后 

分 类 号：R738[医药卫生—肿瘤]