机构地区:[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院乳腺外科,北京100021 [2]首都医科大学附属北京天坛医院乳腺科,北京100070
出 处:《解放军医学杂志》2023年第2期204-210,共7页Medical Journal of Chinese People's Liberation Army
基 金:国家重点研发计划(2019YFE0110000);国家自然科学基金(82072097)。
摘 要:目的 分析原发性乳腺淋巴瘤(PBL)的临床病理学特征并探讨利妥昔单抗对其预后的影响。方法 回顾性分析2000年1月1日-2020年1月31日中国医学科学院北京协和医学院肿瘤医院收治的65例PBL患者的临床病理特征及利妥昔单抗的治疗效果,根据治疗方法的不同分为CHOP组[n=41,采用CHOP方案(环磷酰胺+表阿霉素+长春新碱+泼尼松)]与RCHOP组[n=24,采用利妥昔单抗联合CHOP方案]。采用门诊复查、电话方式随访,随访至患者死亡或截至2022年1月31日,通过单因素和多因素logistic回归分析PBL患者的预后影响因素。结果 共纳入65例PBL患者,均为女性,发病年龄57(23,86)岁,肿瘤大小为2.8(0.4,5.3) cm,随访时间为4.3(0.7,21.8)年。两组Ki-67表达情况差异有统计学意义(P=0.043),其他临床病理特征及治疗方案无明显差异(P>0.05)。65例PBL患者5年、10年总生存率分别为93.4%、87.9%,无进展生存率分别为88.2%、79.6%;中枢神经系统复发率为4.6%。Kaplan-Meier生存分析显示,CHOP组和RCHOP组5年总生存率分别为93.8%、92.9%(P=0.733),5年无进展生存率分别为89.9%、92.9%(P=0.897)。多因素logistic回归分析显示,国际预后指数(IPI)评分和β2微球蛋白水平是影响总生存的独立危险因素(P<0.05)。结论 PBL无特殊临床表现,确诊主要依靠组织病理学检查和免疫表型,根治性手术切除并不能改善患者的预后,其治疗应采用以足疗程化疗为主的综合治疗;PBL患者是否接受利妥昔单抗治疗与生存获益无关。Objective To analyze the clinical and pathological features of primary breast lymphoma(PBL) and explore the value of appling rituximab for the prognosis of patients with PBL. Methods The clinicopathological characteristics and therapeutic effect of rituximab were retrospectively analyzed of 65 patients with PBL admitted in the Cancer Hospital of Peking Union Medical College, Chinese Academy of Medical Sciences from January 1, 2000 to January 31, 2020. According to different treatment methods,they were divided into CHOP group [n=41, using CHOP regimen(cyclophosphamide + epirubicin + vincristine + prednisone)] and RCHOP group(n=24, using rituximab combined CHOP regimen treatment). Patients received telephone follow-up or outpatient review until January 31, 2022 or mortality. Univariate regression analysis and multivariate regression analysis were used to analyze the factors influencing the prognosis of patients with PBL. Results All the 65 patients were female, aged 57(23, 86) years old.The tumor size was 2.8(0.4, 5.3) cm, and the follow-up time was 4.3(0.7, 21.8) years. There was a statistically significant difference in Ki-67 expression between the two groups(P=0.043), and there was no significant difference in other clinicopathological features and treatment plans(P>0.05). The 5-and 10-year overall survival rate of the 65 PBL patients were 93.4% and 87.9%,and the 5-and 10-year progression-free survival rate were 88.2% and 79.6%, the central nervous system recurrence rate was 4.6%.The 5-year overall survival rate in CHOP group was 93.8% and in RCHOP group was 92.9%(P=0.733), and 5-year progressionfree survival rate was 89.9% in CHOP group, and in RCHOP group was 92.9%(P=0.897). Multivariate logistic regression analysis showed the international prognostic index(IPI) score and the level of β2 microglobulin were the independent risk factors of overall survival(P<0.05). Conclusions There is no special clinical manifestation of PBL. The definite diagnosis mainly depends on histopathological examination and immunophen
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