126 例原发胃弥漫大B 细胞淋巴瘤的临床特点及预后分析

Retrospective analysis of the clinical features and prognostic factors of 126 patients with primary gastric diffuse large B-cell lymphoma

  • 摘要: 目的:分析胃弥漫大B 细胞淋巴瘤(DLBCL )的临床特点和预后,以期更好的指导治疗。方法:回顾性收集1999年1 月至2012年3 月中国医学科学院肿瘤医院收治的初治、胃原发DLBCL 患者的临床资料,分析其人口学特点、分期、病理诊断、并发症、治疗和预后等特征。结果:共计纳入研究患者126 例,中位年龄49(16~81)岁,男女比例为6 8 :58。病理诊断为单纯DLBCL 96例、MALT伴大B 细胞转化27例、伴浆样细胞分化3 例。早期患者114 例(90.5%),其治疗方式包括单纯化疗37例、化疗+ 放疗39例、手术+ 化疗± 放疗38例。中位随访48个月,全组患者PFS 和OS分别为75.6% 和82.7% ,早期和晚期患者的PFS 分别为77% 和41.7%(P = 0.005)。 早期患者采用单纯化疗、化放疗联合和含手术治疗的PFS 分别为67.3% 、77.8% 和77.8%(P = 0.588)。 国际预后指数(IPI)评分为0 分、1 分和> 1 分患者的PFS 分别为85.4% ,74.4% 和55.6%(P = 0.011)。 Ⅰ期和Ⅱ期患者的PFS 分别为81.2% 和66.1%(P = 0.018)。 LDH 正常和升高患者的PFS 分别为86.6% 和63.3%(P = 0.006)。 病理类型为单纯DLBCL 和含有MALT成分、生发中心(GCB )和非生发中心(non-GCB )、年龄> 60岁等与预后无关。结论:早期病变比例占胃原发DLBCL 患者的绝大多数。早期患者预后良好,手术切除并不能提高疗效。早期患者中IPI> 1 分、LDH 升高和临床分期II 期提示预后不良。

     

    Abstract: Objective:Primary gastric diffuse large B-cell lymphoma (PGLBCL) is a highly common subtype of extranodal non-Hodgkin lymphoma. We analyzed the disease's clinical features and prognosis to guide better treatment. Methods:We retrospectively collect-ed data from PGLBCL cases seen from January 1999to March 2012in one cancer center. We then analyzed the demographic character-istics, clinical stage, histological diagnosis, complications, treatment, and prognostic characteristics of such patients. Results:A total of 126 patients with median age of 49years old (range: 16- 81years) were included in the study. The male-to-female ratio was 68:58. A to-tal of 96patients were pathologically diagnosed with pure diffuse large B-cell lymphoma (DLBCL),27with mucosa-assouated lymphoid (MALT) component, and 3 with plasmacytoid differentiation. Meanwhile,90% of the patients were in the early stage of the disease. For the early-stage patients, treatment strategy included surgery + chemotherapy ± radiotherapy for38cases, chemoradiotherapy for 39cases, chemotherapy alone for 37cases, and surgery alone for 1 case. Under a median follow up of48months, the 4-year progres -sion free survival (PFS) and overall ourvival (OS) rate of the whole group were 75. 6% and 82. 7%, respectively. PFS rates for early and advanced stage patients were 77% and 41. 7% (P=0. 005 ), respectively. For the early-stage patients treated with chemotherapy alone, chemoradiotherapy, and surgery with therapy, the PFS rates were 67. 3%,77. 8%, and 77. 8% (P=0. 588 ), respectively. The patients with international prognostic index (IPI) score of 0, 1, and > 1 achieved PFS of 85. 4% ,74. 4% , and 55. 6% (P=0. 011 ), respectively. The PFS rates were 81. 2% and 66. 1% (P=0. 018 ) for stages Ⅰand Ⅱ, respectively, and 86. 6% and 63. 3% (P=0. 006 ) for the normal and elevated LDH levels, respectively. The pathological type of pure DLBCL or a MALT component, GCB or non- GCB origin, and age more than 60 years old were not associated with prognosis. Conclusion: The majority of the PGLBCL patients were in the early stage of disease, but the outcome of early- stage disease was favorable. Surgery did not improve outcomes. Univariate analysis demonstrated that IPI score > 1, stage Ⅱdisease, and elevated LDH levels were associated with poor prognosis in the early-stage patient.

     

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