34例原发乳腺非霍奇金淋巴瘤的临床分析  

Clinical analysis of 34 cases of primary non-Hodgkin lymphoma of breast

作　　者：王雪[1] 杨晟[2] 胡少轩[2] 王小兵[3] 秦燕[2] 杨建良[2] 周生余[2] 刘鹏[2] 何小慧[2] WANG Xue YANG Sheng HU Shaoxuan WANG Xiaobing QIN Yan YANG Jianliang ZHOU Shengyu LIU Peng HE Xiaohui(Special Hospital Ward, 21nternal Medicine, 3Cell and Molecular Biology Laboratory, National Cancer Center/Chinese Academy of Medical Sciences ＆ Peking Union Medical College Cancer Hospital, Beijing 100021, China)

机构地区：[1]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院特需病房,北京1000210 [2]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院内科,北京1000210 [3]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院细胞与分子生物学实验室,北京1000210

出　　处：《癌症进展》2017年第5期596-600,共5页Oncology Progress

摘　　要：目的探讨原发乳腺非霍奇金淋巴瘤(PNHLB)的临床病理特征、治疗方案及预后因素。方法收集34例PNHLB住院患者的临床资料,并进行电话或门诊随访,回顾性分析总结患者的临床及病理特征、治疗和生存情况。结果 34例患者均为女性,中位年龄46岁。临床分期Ⅰ期19例(56%),Ⅱ期8例(24%),Ⅲ期1例(3%),Ⅳ期6例(18%)。部分患者进行了Ki-67、Bcl-2、CD10、Bcl-6及Mum-1免疫组化检测。治疗方法包括单纯手术(2例)、手术+化疗(14例)、手术+化放疗(7例)、化疗+放疗(4例)、联合利妥昔单抗(22例)、联合预防性鞘注(2例)及造血干细胞移植(3例)。随访时间0.5~149.0个月,全组死亡8例,中位总生存期(OS)未达到,中位无进展生存期(PFS)为86.0个月(95%CI=16.1~155.9个月)。1、2、3、5年总生存率分别为90.3%、87.0%、83.6%及73.3%,无进展生存率分别为75.1%、61.5%、61.5%及51.0%。Log-rank单因素分析发现肿瘤原发部位、分期、IPI评分与中位OS有关,初始治疗后是否达CR及IPI评分与中位PFS有关。结论 PNHLB多为B细胞来源,其中弥漫大B细胞型最多见,目前主要治疗模式为手术联合放化疗及利妥昔单抗靶向治疗,化疗多采用CHOP方案,同时预防性鞘注可能给患者带来生存获益。Objective To assess the clinicopathological features, treatment regimens and prognostic factors of prima-ry non-Hodgkin＆#39;s lymphoma of breast （PNHLB）. Method The clinical data of thirty-four inpatients with PNHLB were enrolled, and the clinicopathological features, treatment regimens and survival time were retrospectively analyzed through telephone and clinical follow-up. Result All of the 34 cases were female, and the median age was 46. 19 cases （56%） were at phase Ⅰ, 8 cases （24%） at phase Ⅱ, only one case （3%） at phase Ⅲ, and 6 cases （18%） at phase Ⅳ. Ki-67, Bcl-2, CD10, Bcl-6 and Mum-1 were observed by immunohistochemical detection in some of the cases. Treatment regi-mens included surgery alone （2 cases）, surgery＋chemotherapy （14 cases）, surgery＋chemoradiotherapy （7 cases）, che-motherapy＋radiotherapy （4 cases）, Rituximab in combination （22 cases）, preventive intrathecal injection in combination （2 cases） and hematopoietic stem cell transplantation （3 cases）. The duration of follow-up was 0.5 to 149.0 months, 8 pa-tients died. The median OS was not reached, and the median PFS was 86.0 months （95%CI=16.1-155.9 months）. The 1-, 2-, 3-and 5-year overall survival rates were 90.3%, 87.0%, 83.6%and 73.3%, respectively;the progression-free survival rates were 75.1%, 61.5%, 61.5%and 51.0%, respectively. Results of Log-rank univiarate analysis showed that, the prima-ry site of the tumor, clinical stage and IPI score were related to median OS;whether CR were reached after treatment and IPI score were related to median PFS. Conclusion PNHLB tends to be of B-cell origin, with the majority being diffuse large B cell lymphoma （DLBCL）. At present, the main treatment mode for PNHLB is surgery combined with radiothera-py, chemotherapy and Rituximab targeted therapy. CHOP is the main chemotherapy regimen, and preventive intrathecal injection may improve patient survival.

关 键 词：非霍奇金淋巴瘤 乳腺 综合治疗 预后因素 

分 类 号：R737.9[医药卫生—肿瘤]