180例原发性胃肠道淋巴瘤的临床特征及预后分析  

The clinical features and prognosis analysis of 180 patients diagnosed as primary gastrointestinal lymphoma

作　　者：李瑶[1] 高欣[1] 贾振宇[1] 许春舫[1] LI Yao;GAO Xin;JIA Zhenyu;XU Chunfang(Department of Gastroenterology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院消化科

出　　处：《胃肠病学和肝病学杂志》2019年第11期1237-1241,共5页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探讨原发性胃肠道淋巴瘤(primary gastrointestinal lymphoma,PGIL)的临床特点并分析影响其预后的相关因素。方法收集2006年1月至2016年1月于苏州大学附属第一医院就诊的PGIL患者,分析其临床特征及预后,并进行相关统计学分析。结果共180例患者纳入此研究,男102例,女78例,中位发病年龄为59岁。PGIL临床表现多样,较常见的为:腹痛、腹胀、消化道出血、体质量减轻、大便习惯或性状改变。胃淋巴瘤101例,其最常见的发病部位为胃窦(66例,65.34%),首次胃镜检查活检准确率为43.30%;肠道淋巴瘤79例,其中小肠44例(55.70%),结直肠35例(44.30%),首次结直肠镜检查活检准确率为24.00%。在180例患者中B细胞淋巴瘤为160例,其中以弥漫性大B细胞淋巴瘤(DLBCL)(57.22%)及黏膜相关淋巴组织(MALT)淋巴瘤(19.44%)多见;T细胞淋巴瘤为20例。根据Ann Arbor改良分期,ⅠE期病例49例,ⅡE期48例,Ⅲ期28例,Ⅳ期55例。PGIL的3年生存率为57.39%,其中年龄>60岁、病变位于小肠、临床分期处于Ⅲ/Ⅳ期、IPI指数≥3、LDH表达高水平、T细胞源性及单纯手术的患者其预后较差,临床分期为影响PGIL患者预后的独立危险因素。生存分析结果显示,手术联合化疗的预后要优于单纯手术,且与临床分期有关。结论PGIL好发于中老年男性,以胃淋巴瘤最为常见,其中DLBCL和MALT淋巴瘤是最常见的病理类型。年龄>60岁、病变位于小肠、临床分期处于Ⅲ/Ⅳ期、IPI指数≥3、LDH表达高水平、T细胞源性及单纯手术的预后较差。手术联合化疗适用于临床分期处于Ⅲ/Ⅳ期的患者。Objective To investigate the clinical features and prognosis in primary gastrointestinal lymphoma(PGIL).Methods The clinical data of 180 PGIL patients in the First Affiliated Hospital of Soochow University from Jan.2006 to Jan.2016 were collected.The clinical features and prognosis were analyzed,and statistical analysis was used.Results A total of 180 patients were included in this study,among these patients,102 were male and 78 were female,with a median age of 59 years old.Abdominal pain,distention,gastrointestinal bleeding,weight loss,stool habits or trait changes were common among these patients.101 patients were gastric lymphoma,with 65.34%of lesions were located at gastric antrum,the diagnostic accuracy of gastroscope was 44.30%.79 patients were intestinal lymphoma,with 55.70%of lesions were located at small intestine,the diagnostic accuracy of enteroscope was 24.00%.160 patients were diagnosed as B-cell lymphoma,20 patients were diagnosed as T-cell lymphoma.Diffuse large B cell lymphoma(PLBCL)and mucosa associated lymphoid tissue(MALT)were the most common pathological subtype,with the incidence of 57.22%and 19.44%.49 patients were classified as Ⅰ E stage,48 patients as Ⅱ E stage,28 patients as Ⅲ stage and 55 patients asⅣstage according to Ann Arbor.The 3-year survival rate of PGIL was 57.39%,moreover,age>60 years old,small intestine lymphoma,advanced stage,IPI score≥3,elevated LDH level,T-cell lymphoma and surgical treatment alone were associated with poor prognosis.Cox analysis showed that clinical stage was the significant independent prognostic factor.Besides,the prognosis of surgery with chemotherapy was better than surgery alone,which was associated with clinical stage.Conclusion PGIL is most commonly seen in middle aged male,which is mainly represented as gastric lymphoma.DLBCL and MALT are the most common pathological subtype.Age>60 years old,small intestine lymphoma,advanced stage,IPI score≥3,elevated LDH level,T-cell lymphoma and surgical treatment alone are associated with poor prognos

关 键 词：原发性胃肠道淋巴瘤 临床特点 预后因素 

分 类 号：R735.2[医药卫生—肿瘤]