继发性B细胞型非霍奇金淋巴瘤患者的临床特征分析  

Clinical characteristics of patients with secondary B-cell non-Hodgkin lymphoma

作　　者：苗昭艺 姜亚楠 王金焕[2] 吕扬扬 邢东慧 徐鸿 翟翊辛 赵智刚 MIAO Zhao-yi;JIANG Ya-nan;WANG Jin-huan;LYU Yang-yang;XING Dong-hui;XU Hong;ZHAI Yi-xin;ZHAO Zhi-gang(Department of Hematology,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin Clinical Research Center for Cancer,Tianjin 300060,China;Department of Oncology,the Second Hospital of Tianjin Medical University)

机构地区：[1]天津医科大学肿瘤医院血液科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津市恶性肿瘤临床医学研究中心,300060 [2]天津医科大学第二医院肿瘤科

出　　处：《天津医药》2020年第8期748-752,共5页Tianjin Medical Journal

基　　金：国家自然科学基金资助项目(81670102,81870150);天津市自然科学基金资助项目(16JCYBJC25200)。

摘　　要：目的探讨继发于非血液系统恶性肿瘤的B细胞型非霍奇金淋巴瘤(sNHL)患者的临床特征及预后情况。方法2007年1月—2018年5月就诊于我院的NHL患者中,1.65%(47/2853)以第二恶性肿瘤的形式出现,其中44例为B细胞型sNHL。44例中第一原发恶性肿瘤治疗情况:29例为手术切除治疗,10例为手术联合化疗,2例为手术联合放疗,3例接受手术联合化疗及放疗。继发肿瘤的治疗情况:34例患者接受化疗,5例患者接受化疗+手术切除,4例患者因结外病变或巨大包块接受放疗,1例结外边缘区B细胞淋巴瘤,黏膜相关淋巴组织型淋巴瘤(胃型)患者仅接受抗幽门螺杆菌治疗。中位化疗时间为6(2,8)个月。CD20+的弥漫大B细胞淋巴瘤(DLBCL)或CD20+Ⅲ~Ⅳ期滤泡淋巴瘤(FL)患者在化疗前1 d静脉滴注利妥昔单抗(375 mg/m2)。中位随访时间11.4(4.2,28.8)个月。结果44例sNHL患者最常见的第一原发恶性肿瘤疾病类型为乳腺癌(10例),最常见的sNHL病理类型为DLBCL(29例)。65.9%(29/44)的患者第一原发肿瘤诊断年龄<60岁,59.1%(26/44)的患者sNHL诊断年龄≥60岁。中位sNHL发生时间为63.4(25.2,146.9)个月。平均无疾病进展时间为9.6(4.1,26.0)个月。3年总生存率为73.5%。一线治疗后完全缓解率为38.6%,总缓解率为63.6%。利妥昔单抗组与未利用利妥昔单抗组的3年总生存率分别为81.1%和66.5%(Log-rankχ2=2.026,P>0.05)。单因素分析显示第一原发恶性肿瘤诊断年龄≥60岁(Log-rankχ2=7.562,P<0.05),sNHL诊断年龄≥60岁(Log-rankχ2=4.887,P<0.05)均提示预后不良;多因素分析显示第一原发恶性肿瘤发病年龄≥60岁(HR=4.745,95%CI:1.405~16.020)是影响sNHL患者生存率的独立危险因素。结论第一原发恶性肿瘤的诊断年龄≥60岁会增加sNHL患者的死亡风险。Objective To investigate the clinical characteristics and prognosis of patients with B-cell secondary non-Hodgkin lymphoma(sNHL).Methods From January 2007 to May 2018,among the NHL patients treated in our hospital,1.65%(47/2853)appeared in the form of a second malignant tumor,of which 44 cases were B-cell sNHL.The treatment of the first primary malignant tumor in 44 sNHL:29 cases accepted surgical resection,10 cases received surgery combined with chemotherapy,2 cases received surgery combined with radiotherapy,and 3 cases received surgery combined with chemotherapy and radiotherapy.The treatment of secondary lymphoma:34 patients received chemotherapy,5 patients received chemotherapy combined with surgery,4 patients received radiotherapy for extranodal primary sites or massive masses,one patient received the treatment of anti-helicobacter pylori eradication since the extracellular nodal marginal zone B-cell lymphoma and mucosa-associated lymphoid tissue lymphoma(gastric type).The median time of chemotherapy was 6(2,8)months.Patients with CD20+DLBCL or CD20+FL that were stageⅢtoⅣwere infused with rituximab(375 mg/m2)intravenously one day before chemotherapy.The median follow-up time was 11.4(0.5,145.3)months.Results For the 44 sNHL patients,breast cancer(n=10)was the most common type of primary malignancies before NHL.The most common type of NHL was diffuse large b-cell lymphoma(DLBCL,n=29).For 44 sNHL patients,65.9%(29/44)patients were diagnosed the first primary tumor at age<60 years,and 59.1%(26/44)patients were diagnosed with sNHL at age≥60 years.The median survival time without a second tumor was 63.4(25.2,146.9)months.The median follow-up time of 44 sNHL was 11.4(4.2,28.8)months,and the average disease-free survival(DFS)time was 9.6(4.1,26.0)months.The 3-year overall survival(OS)was 73.5%.The complete remission rate(CR)was 38.6%after first-line treatment,and the overall response rate(RR)was 63.6%.The 3-year overall survival rates were 81.1%and 66.5%for patients received rituximab and patients without ri

关 键 词：淋巴瘤 非霍奇金 淋巴瘤 B细胞 肿瘤 多原发性 肿瘤 继发原发性 存活率分析 预后 

分 类 号：R733.4[医药卫生—肿瘤]