原发性乳腺弥漫性大B细胞淋巴瘤的临床特点、MRI表现、治疗方式与预后关系分析  

Analysisi of the relationship between clinical features,magnetic resonance imaging,treatment and prognosis of primary breast diffuse B cell lymphoma

作　　者：范林音 邵国良[1,2,3] 朱秀[1,4,5] 杨永波 刘璐璐[1,2,3] 何向明[1,6,7] FAN Linyin;SHAO Guoliang;ZHU Xiu;YANG Yongbo;LIU Lulu;HE Xiangming(Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Hangzhou 310022, P.R.China;Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou 310022, P.R.China;Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, P.R.China;Department of Pathology, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou 310022, P.R.China;Department of Pathology, Zhejiang Cancer Hospital, Hangzhou 310022, P.R.China;Department of Breast Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou 310022, P.R.China;Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, P.R.China)

机构地区：[1]中国科学院肿瘤与基础医学研究所,浙江杭州310022 [2]中国科学院大学附属肿瘤医院放射科,浙江杭州310022 [3]浙江省肿瘤医院放射科,浙江杭州310022 [4]中国科学院大学附属肿瘤医院病理科,浙江杭州310022 [5]浙江省肿瘤医院病理科,浙江杭州310022 [6]中国科学院大学附属肿瘤医院乳腺外科,浙江杭州310022 [7]浙江省肿瘤医院乳腺外科,浙江杭州310022

出　　处：《医学影像学杂志》2020年第8期1388-1393,共6页Journal of Medical Imaging

基　　金：浙江省医药卫生科技计划项目(编号:2017KY026)。

摘　　要：目的探讨原发性乳腺弥漫性大B细胞淋巴瘤(primary breast diffuse large B-celllymphoma,PBDLBCL)的临床特点、MRI特征、治疗方式与预后的关系。方法回顾性分析我院35例PBDLBCL病例,包括基本资料、临床表现、MRI表现、治疗方式及预后。结果35例患者均为女性;Ann Arbor分期,ⅠE期13例,ⅡE期13例,Ⅳ期9例;国际预后指数:IPI 0~1分24例,2分5例,3~4分6例;实验室检查:LDH<240U/L16例,LDH(240~500U/L)13例,LDH>500U/L 6例。单因素分析检验显示临床分期、LDH水平、IPI评分、病灶长径、是否行外科切除的3年、5年生存率差异有统计学意义,年龄、信号是否均匀、ADC值、增强曲线类型、是否有血管穿行征象、是否有扩张导管征象、是否接受放疗对预后影响的差异无统计学差异。多因素分析显示IPI危险分级增加为PBDLBCL独立的不良预后因素之一。结论PBDLBC的预后与病灶大小、分期,LDH水平相关,预后需多因素综合评价,IPI危险分级增加是PBDLBCL独立的不良预后因素。Objective To investigate the relationships of clinical features,MRI features and treatment methods of patients with the prognosis of primary breast diffuse large B-cell lymphoma(PBDLBCL).Methods From January 2006 to December 2017,the clinical data of 35 patients with PBDLBCL who were admitted to our hospital were analysed retrospectively,including essential data,clinical manifestations,MRI features,treatment methods and prognosis.Results There were 35 females aged 24~79 years old,with a median age of 47 years old.According to the ann arbor staging system,there were 13 cases of stage IE,13 cases of stage IIE and 9 cases of stage IV.As for the international prognostic index(IPI),24 cases had 0~1 point,5 cases had 2 points and 6 cases had 3~4 points.Regarding laboratory examinations,there were 16 cases of LDH<240 U/L,13 cases of LDH=240~500 U/L and 6 cases of LDH>500 U/L.Univariate analysis showed that there were significant differences in 3-year and 5-year survival rates in terms of clinical stages,LDH levels,IPI scores,length-diameters of lesions and surgical resection,but no significant differences in the prognostic impact regarding age,the presence of a homogeneous signal,ADC values,enhancement of curve types,signs of blood vessels passing through lesions,signs of duct ectasia and radiotherapy.Multivariate analysis revealed that the increase of IPI risk classification was one of the independent risk factors for poor prognosis in patients with PBDLBCL.Conclusion Lesion size,stage and LDH level were potentially related to the prognosis of PBDLBCL.Thus,multiple factors are needed for the comprehensive evaluation concerning the prognosis of PBDLBCL,and the increase in the IPI risk classification may be an independent risk factor for poor prognosis in patients with PBDLBCL.

关 键 词：乳腺淋巴瘤 弥漫性大B细胞淋巴瘤 磁共振成像 

分 类 号：R733.1[医药卫生—肿瘤] R445.2[医药卫生—临床医学]