151例纵隔肿块起病的淋巴瘤临床特征以及预后分析  

Clinical characteristics and prognostic analysis of 151 cases of lymphoma with mediastinal masses

作　　者：李潇 张慕晨 钱樱[1] 程澍[1] 许彭鹏[1] 赵维莅[1] 沈志祥[1] 王黎[1] LI Xiao;ZHANG Muchen;QIAN Ying;CHENG Shu;XU Pengpeng;ZHAO Weili;SHEN Zhixiang;WANG Li(State Key Laboratory of Medical Genomics,Shanghai Institute of Hematology,Rui Jin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院,医学基因组学国家重点实验室,上海血液学研究所,上海200025

出　　处：《临床血液学杂志》2021年第11期765-770,775,共7页Journal of Clinical Hematology

基　　金：国家自然科学基金(No:81670176、81830007、81770205);上海市教育委员会高峰高原学科计划(No:20152206、20152208);上海交通大学临床研究计划(No:16CR2017A);上海交通大学医学院多中心临床研究项目(No:DLY201601)。

摘　　要：目的:探究纵隔肿块起病的淋巴瘤患者临床特征以及预后分析。方法:回顾性收集2010年1月至2021年4月收治的151例以纵隔肿块起病的淋巴瘤患者临床资料,采用Kaplan-Meier方法计算生存期,并采用COX模型进行预后因素分析。结果:纳入研究的151例患者中,男76例,女75例,中位年龄32岁。按照病理分型分析,44例(29.1%)霍奇金淋巴瘤,35例(23.2%)弥漫大B细胞淋巴瘤,32例(21.2%)原发纵隔大B细胞淋巴瘤,32例(21.2%)淋巴母细胞淋巴瘤,3例(2.0%)成熟外周T细胞淋巴瘤,3例(2.0%)灰区淋巴瘤,2例(1.3%)黏膜相关淋巴组织淋巴瘤。肿块侵犯部位以前纵隔居多(140例,92.7%),其次为前中纵隔(7例,4.6%),后纵隔(2例,1.3%)和后中纵隔(2例,1.3%)。根据病理类型进行生存分析,霍奇金淋巴瘤患者的预后最佳,3年无进展生存率和3年总生存率分别为93.2%和100.0%。多因素分析发现,疾病分期晚(Ⅲ~Ⅳ期)是影响患者无进展生存(P=0.0051)和总生存(P=0.0337)的独立预后不良因素。结论:纵隔肿块起病的淋巴瘤以霍奇金淋巴瘤、弥漫大B细胞淋巴瘤、原发纵隔弥漫大B细胞淋巴瘤和淋巴母细胞淋巴瘤这几种病理亚型为主,侵犯部位主要为前纵隔,在这些亚型中,霍奇金淋巴瘤预后最佳。Objective:To analyze the clinical features and prognostic factors of lymphoma patients with mediastinal masses.Methods:The clinical data of 151 lymphoma patients with mediastinal masses treated in Ruijin hospital from January 2010 to April 2021 was collected and analyzed retrospectively.Overall survival(OS)and progressive-free survival(PFS)were analyzed by Kaplan-Meier method.Univariate and multivariable analysis was performed to explore the risk factors for survival with COX proportional hazard model.Results:In this study,151 patients(76 males and 75 females)with a median age of 32(14-76)years old were recruited.According to the pathological classification,44 cases(29.1%)were Hodgkin’s lymphoma(HL),35 cases(23.2%)were diffuse large B cell lymphoma(DLBCL),32 cases(21.2%)were primary mediastinal large B cell lymphoma(PMBCL),32 cases(21.2%)were lymphoblastic lymphoma/acute lymphoblastic leukemia(LBL/ALL),3 cases(2.0%)were peripheral T cell lymphoma(PTCL),3 cases(2.0%)were primary mediastinal grey zone lymphoma(MGZL)and 2 cases(1.3%)were mucosa-associated lymphoid tissue(MALT)lymphoma.The anterior mediastinum was most affected(140 cases,92.7%),followed by anterior and middle mediastinum in 7 cases(4.6%).However,2 cases(1.3%)had posterior mediastinum involved and 2 cases(1.3%)had the posterior and middle mediastinum masses.For outcome,HL patients had the best outcome,with 3-year PFS 93.2%and 3-year OS 100.0%.The multivariate analysis showed that advanced stage(Ⅲ/Ⅳ)was independent unfavorable factor of PFS(P=0.0051)and OS(P=0.0337).Conclusion:Lymphomas presented with mediastinal masses are mainly HL,DLBCL,PMBCL and LBL subtypes,and the anterior mediastinum are the overwhelmingly affected site.Among patients with mediastinal masses,HL has the better outcome than other lymphoma subtypes.

关 键 词：纵隔肿块 淋巴瘤 预后 

分 类 号：R733.4[医药卫生—肿瘤]