62例原发肠道恶性淋巴瘤患者的临床观察  

Clinical observation of 62 patients with primary intestinal malignant lymphoma

作　　者：吕成兰[1] 王晶[1] 徐岳一[1] 许景艳[1] LYU Chenglan;WANG Jing;XU Yueyi;XU Jingyan(Department of Hematology,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院血液内科,南京210008

出　　处：《临床肿瘤学杂志》2024年第5期474-478,共5页Chinese Clinical Oncology

摘　　要：目的探讨原发肠道恶性淋巴瘤(PIL)的临床特征、诊断治疗方法及预后的因素。方法收集2018年1月1日至2022年12月31日在南京大学医学院附属鼓楼医院诊治的PIL患者的临床病历资料,包括性别、年龄、血红蛋白、乳酸脱氢酶(LDH)水平、EB病毒感染、肿瘤细胞来源、病理类型、国际预后指数(IPI)评分、临床分期等,并进行回顾性总结分析。结果共收集符合诊断标准的患者62例,男女比例为2.4:1,中位年龄57岁;Ⅳ期42例;47例行消化内镜检查,内镜下活检明确诊断淋巴瘤的患者为40例;结直肠和小肠淋巴瘤分别为27例和32例;61例为非霍奇金淋巴瘤,其中B细胞来源55例,弥漫大B细胞淋巴瘤(DLBCL)41例。62例患者全部接受治疗,其中56例全身化疗,35例手术治疗。治疗期间获完全缓解(CR)31例,部分缓解(PR)11例,获疾病稳定(SD)和病情进展(PD)6例。62例患者的中位总生存期(OS)未达到,5年生存率为66.64%。<50岁患者的中位OS明显优于≥50岁患者(P<0.05);根据IPI分为相对低危组(IPI 0~2分)和相对高危组(IPI 3~5分),两组患者的5年生存率分别为78.18%和50.69%,差异有统计学意义(P<0.05);B细胞来源和T细胞来源PIL患者的中位OS分别为未达到和5.8年,差异有统计学意义(P<0.05);DLBCL患者的5年生存率为77.69%;EB病毒血症的患者预后相对更差(P<0.05);化疗联合手术治疗(26例)和单纯化疗(32例)患者的中位OS均未达到,差异无统计学意义(P>0.05)。多因素Cox回归分析显示,T细胞来源和EB病毒血症是影响OS的独立预后因素(P<0.05)。结论PIL好发于男性,小肠淋巴瘤稍多于结直肠淋巴瘤,病理类型主要为非霍奇金淋巴瘤,其中DLBCL占大多数。多数患者经内镜活检诊断。多数患者需通过化疗达到CR或PR。T细胞来源和EB病毒血症为预后不良的独立因素。手术未增加PIL患者的生存风险。Objective To investigate the clinical features,diagnosis,treatment and prognostic factors of primary intestinal lymphoma(PIL).Methods Clinical medical records of PIL patients treated in Drum Tower Hospital Affiliated to the School of Medicine of Nanjing University from January 1,2018 to December 31,2022 were collected,including gender,age,hemoglobin,lactate dehydrogenase(LDH),Epstein-Barr virus(EBV),tumor cell source,histologic type,IPI index and clinical stage,etc.,and were retrospectively summarized and analyzed.Results In this study,62 patients consistent with the diagnosis were collected,with a male to female ratio of 2.4∶1.The median age was 57 years.There were 42 cases in stage IV.Forty-seven patients underwent digestive endoscopy,and 40 patients were diagnosed with lymphoma by endoscopic biopsy.Colorectal and small intestine lymphoma were found in 27 and 32 cases,respectively.Sixty-one cases were non-Hodgkin lymphoma,of which 55 were B-cell origin and 41 were diffuse large B-cell lymphoma(DLBCL).All 62 patients received treatment,including 56 patients with systemic chemotherapy and 35 patients with surgery.During treatment,31 cases achieved complete response(CR),11 cases achieved partial response(PR),and 6 cases achieved stable disease(SD)and disease progression(PD).Median overall survival(OS)was not achieved in 62 patients,and 5-year survival rate was 66.64%.The median OS of patients<50 years old was significantly better than that of patients≥50 years old(P<0.05).According to IPI,patients were divided into relatively low-risk group(IPI 0-2 points)and relatively high-risk group(IPI 3-5 points).The 5-year survival rates of the two groups were 78.18%and 50.69%,respectively,and the difference was statistically significant(P<0.05).The median OS of PIL patients from B cell source and T cell source was not reached and 5.8 years,respectively,and the difference was statistically significant(P<0.05).The 5-year survival rate of DLBCL patients was 77.69%.The prognosis of patients with EBV viremia was worse(P<0.05

关 键 词：非霍奇金淋巴瘤 肠道淋巴瘤 诊断和治疗 预后 

分 类 号：R733[医药卫生—肿瘤]