原发性胃肠道非霍奇金淋巴瘤的临床特征及预后因素分析  

Clinical Features and Prognostic Factors of Primary Gastrointestinal Non-Hodgkin's Lymphoma

作　　者：李少玲[1] 付骞千[1] 张甜甜[1] 高大林[1] 翟琼莉[1] 

机构地区：[1]天津医科大学肿瘤医院病理科,天津市"肿瘤防治"重点实验室,国家肿瘤临床医学研究中心,天津市恶性肿瘤临床医学研究中心,天津300060

出　　处：《肿瘤防治研究》2017年第1期28-33,共6页Cancer Research on Prevention and Treatment

基　　金：国家自然科学基金(81272361)

摘　　要：目的总结原发性胃肠道非霍奇金淋巴瘤(primary gastrointestinal non-Hodgkin’s lymphoma,PGINHL)的临床及病理学特点,分析影响其预后的因素。方法回顾分析272例PGINHL患者的临床资料。结果 272例病例中,男女比例1.32:1;初诊平均年龄55.96岁,中位年龄58.85岁(4.85~92.87岁);发病部位:胃180例(66.2%),小肠31例(11.4%),回盲部19例(7.0%),结肠19例(7.0%),直肠4例(1.5%),盲肠和肛门各1例(各0.4%),多发部位病变17例(6.25%);B细胞淋巴瘤259例(95.2%),T/NK细胞淋巴瘤13例(4.8%);PGINHL患者3年和5年总生存率分别为87.5%和82.2%;单纯手术对弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)预后有不良影响。手术联合化疗、化疗联合放疗和手术联合放化疗的治疗方案对DLBCL预后的影响无差异;单因素分析显示年龄>60岁、T细胞表型、进展期、高aaIPI危险等级评分、B症状、乳酸脱氢酶(actate dehydrogenase,LDH)、β2微球蛋白(beta 2 microspheres,β2-MG)升高,Ki67>40%和肿瘤最大直径≥10 cm是PGINHL患者预后不良的危险因素,Cox风险模型显示T/NK细胞表型、aaIPI评分危险分级增加、高水平的β2-MG和高Ki67指数是PGINHL独立的不良预后因素。结论病理类型、aaIPI评分、β2-MG和Ki67是影响PGINHL预后的因素,患者可以选择化疗或者化疗联合放疗的治疗方案。Objective To summarize the clinical manifestation, pathological features of primary gastrointestinal non-Hodgkin＇s lymphoma（PGINHL） and investigate their prognostic factors. Methods The clinical data of 272 patients diagnosed as PGINHL was analyzed retrospectively. Results Man versus female was 1.32：1（155：117） with an average diagnosed age of 55.96 years, the median diagnosed age was 58.85 years（range 4.85-92.87 years）. The most commen lesions was stomach（180 cases, 66.2%）, followed by small bowel（31 cases,11.4%）, ileocecum（19 cases,7%）, colon（19 cases,7%）, rectum（4 cases, 1.5%）, caecum and anus（each 1 cases, 0.4%）, while multiple involvement were 17 cases（6.25%）. 259 cases（95.2%） were classified as B cell lymphoma, while T/NK cell lymphoma were 13 cases（4.8%）. 3 years and 5 years over survival rates of patients were 87.5% and 82.2%, respectively. Simple surgical gained the worst survival status, while there were no obvious differences between chemotherapy combined surgical or radiotherapy and surgical combined chemotherapy. Univariate analysis revealed that age60 years, T cell phenotype, advanced phase patients, high age adjusted IPI risk score, high actate dehydrogenase（LDH） level and β2-MG level, Ki6740% and the tumor diameter≥10 cm were predictors for poor prognosis, Cox hazard modeling was used to analysis that T cell type, higher aaIPI risk score, beta 2 microspheres（β2-MG） level and Ki67 were independent predictors for overall survival of patients with PGINHL. Conclusion pathological type, LDH, β2-MG and Ki67 were not preferential survival factors for PGINHL. PGINHL patients can choose chemotherapy or chemotherapy combined with radiotherapy as the first-line treatment regimen.

关 键 词：非霍奇金淋巴瘤 B细胞淋巴瘤 胃肠道 临床 预后 

分 类 号：R733.1[医药卫生—肿瘤]