Analysis of Clinical Characteristics of Granulocytic Sarcoma from Twenty-eight Cases
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摘要: 目的 探讨粒细胞肉瘤(GS)患者的临床特点、治疗及预后。方法回顾性分析2003年2月—2011年6月期间本院收治的28例GS 患者的临床特点及治疗方法，并进行随访，应用Kaplan-Meier法进行生存分析，应用Log rank检验进行差异显著性检验。结果28例GS患者中男18例，女10例，中位年龄40岁。好发部位为淋巴结、皮下、骨、乳腺等。28例GS患者两年总生存率为21.4%。14例患者初诊时被误诊，误诊与非误诊患者生存率比较差异有统计学意义（P=0.018）。白血病性与非白血病性GS患者的生存率比较差异无统计学意义（P=0.093）。正常核型患者中位生存时间明显优于核型异常者（22月vs.8月），且生存率比较差异有统计学意义（P=0.049）。不同治疗组患者生存率比较差异有统计学意义（P=0.031），移植组患者中位生存时间明显优于常规治疗组及强化疗组（36月、17月、22月）。结论GS在临床表现多样化，易误诊，复发率高，预后差，存在染色体核型异常提示预后不良，确诊后应及时化疗，且早期高强度的化疗可延缓复发，提高长期生存率，造血干细胞移植(HSCT)治疗能明显延长生存期，并有望改善生存。Abstract: Objective To investigate the clinical manifestations,treatment and prognosis of granulocytic sarcoma (GS). Methods A retrospective analysis regarding the clinical characteristics and treatment was performed in 28 GS patients.In addition,there was a clinical follow-up.Meanwhile, survival analysis was done using Kaplan-Meier,so did the significant difference test using Log rank. Results There were 18 males and 10 females,with a median age of 40 years.The predilection sites included lymph nodes,subcutaneous tissue,bone,breast and so on The total two-year survival rate was 21.4%.Fourteen patients were misdiagnosed when initially diagnosed,significant difference was identified between their survival rate and those were not (P=0.018).There was no significant difference in survival rate between leukemic and non-leukemic GS patients(P=0.093).The median survival time of patients with normal karyotypes was significantly longer than those with abnormal ones (22 months vs.8 months).(P=0.049). And survival rate difference was statistically significant among different theraputic groups (P=0.031).The median survival time of patients received bone marrow stem cells transplantion was significantly longer than the conventional therapy group and high-intensity chemotherapy group (36 months vs.17,22 months,respectively). Conclusion GS is frequently misdiagnosed due to the diverse clinical manifestations.Besides,it relapses easily and tends to have poor prognosis,especially in those with abnormal karyotype.Therefore,chemotherapy should be timely conducted after confirmed diagnosis.Our outcomes also indicate that early intensive chemotherapy may delay relapsing and improving long-term survival rate.Moreover,hematopoietic stem cell transplantation can significantly prolong the survival time and even improve survival quality.
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Key words:
- Granulocytic sarcoma /
- Prognosis /
- Therapy /
- Cytogenetics /
- Survival analysis
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