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原发性胃肠道非霍奇金淋巴瘤的临床特征及预后因素分析

Clinical Features and Prognostic Factors of Primary Gastrointestinal Non-Hodgkin's Lymphoma

  • 摘要:
    目的 总结原发性胃肠道非霍奇金淋巴瘤(primary gastrointestinal non-Hodgkin’s lymphoma, PGINHL)的临床及病理学特点,分析影响其预后的因素。
    方法 回顾分析272例PGINHL患者的临床资料。
    结果 272例病例中,男女比例1.32:1;初诊平均年龄55.96岁,中位年龄58.85岁(4.85~92.87岁);发病部位:胃180例(66.2%),小肠31例(11.4%),回盲部19例(7.0%),结肠19例(7.0%),直肠4例(1.5%),盲肠和肛门各1例(各0.4%),多发部位病变17例(6.25%);B细胞淋巴瘤259例(95.2%),T/NK细胞淋巴瘤13例(4.8%);PGINHL患者3年和5年总生存率分别为87.5%和82.2%;单纯手术对弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma, DLBCL)预后有不良影响。手术联合化疗、化疗联合放疗和手术联合放化疗的治疗方案对DLBCL预后的影响无差异;单因素分析显示年龄 > 60岁、T细胞表型、进展期、高aaIPI危险等级评分、B症状、乳酸脱氢酶(actate dehydrogenase, LDH)、β2微球蛋白(beta 2 microspheres, β2-MG)升高,Ki67 > 40%和肿瘤最大直径≥10 cm是PGINHL患者预后不良的危险因素,Cox风险模型显示T/NK细胞表型、aaIPI评分危险分级增加、高水平的β2-MG和高Ki67指数是PGINHL独立的不良预后因素。
    结论 病理类型、aaIPI评分、β2-MG和Ki67是影响PGINHL预后的因素,患者可以选择化疗或者化疗联合放疗的治疗方案。

     

    Abstract:
    Objective To summarize the clinical manifestation, pathological features of primary gastrointestinal non-Hodgkin's lymphoma (PGINHL) and investigate their prognostic factors.
    Methods The clinical data of 272 patients diagnosed as PGINHL was analyzed retrospectively.
    Results Man versus female was 1.32:1(155:117) with an average diagnosed age of 55.96 years, the median diagnosed age was 58.85 years (range 4.85-92.87 years). The most commen lesions was stomach (180 cases, 66.2%), followed by small bowel (31 cases, 11.4%), ileocecum (19 cases, 7%), colon (19 cases, 7%), rectum (4 cases, 1.5%), caecum and anus (each 1 cases, 0.4%), while multiple involvement were 17 cases (6.25%). 259 cases (95.2%) were classified as B cell lymphoma, while T/NK cell lymphoma were 13 cases (4.8%). 3 years and 5 years over survival rates of patients were 87.5% and 82.2%, respectively. Simple surgical gained the worst survival status, while there were no obvious differences between chemotherapy combined surgical or radiotherapy and surgical combined chemotherapy. Univariate analysis revealed that age > 60 years, T cell phenotype, advanced phase patients, high age adjusted IPI risk score, high actate dehydrogenase (LDH) level and β2-MG level, Ki67 > 40% and the tumor diameter≥10 cm were predictors for poor prognosis, Cox hazard modeling was used to analysis that T cell type, higher aaIPI risk score, beta 2 microspheres (β2-MG) level and Ki67 were independent predictors for overall survival of patients with PGINHL.
    Conclusion pathological type, LDH, β2-MG and Ki67 were not preferential survival factors for PGINHL. PGINHL patients can choose chemotherapy or chemotherapy combined with radiotherapy as the first -line treatment regimen.

     

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