原发性脾脏淋巴瘤24例临床预后分析

Prognosis Analysis of 24 Patients with Primary Splenic Lymphoma

目的分析原发性脾脏淋巴瘤(primary splenic lymphoma,PSL)的临床病理特征,探讨各临床指标与预后的关系。方法回顾分析1998年1月-2008年12月我院收治的经病理证实24例PLS患者的临床资料及随访结果,应用SPSS17.0软件进行生存分析,并对各临床指标进行log-rank单因素、Cox模型多因素分析。结果 24例PSL患者中,男15例,女9例,中位年龄43岁(18～78岁),超过60岁者5例,中位生存时间71个月,3年总生存率67.9%,5年总生存率46.6%。其中霍奇金淋巴瘤(Hodgkin′s lymphoma,HL)1例,非霍奇金淋巴瘤(nonHodgkin′s lymphoma,NHL)23例。23例NHL患者中,T细胞型6例,B细胞型17例;ECOG行为状态(performancestatus,PS)0～2分16例,3～4分7例;伴消瘦、发热B症状11例;脾脏轻度肿大6例,中重度肿大17例;血乳酸脱氢酶(serum lactate dehydrogenase,LDH)升高11例;log-rank单因素分析显示年龄、PS评分、B症状、LDH、病理免疫分型与生存相关。Cox模型多因素分析发现LDH、脾脏肿大程度与总生存无关。结论 PSL在本组患者男性高于女性,病理以B细胞NHL为主,年龄、PS评分、B症状、免疫分型与预后有关,T细胞PSL预后差。

Objective To investigate the clinical and pathological features of primary splenic lymphoma （PSL）,and to discuss the relationship between clinical data and the prognostic factors.Methods The clinical data and follow-up surveys of 24 patients with PSL,admitted during the period from January 1998 to December 2008,were analyzed retrospectively,with all patients being confirmed pathologically.SPSS 170 was used for survival analysis,and clinical data were analyzed by log-rank single factor and Cox multivariate model.Results Of the 24 patients,15 were male,and 9 were female,the median age was 43 （18 to 78）;5 were more than 60 years old.Median survival time was 71 months,the 3-year and 5-year overall survival rates were 67.9% and 46.6%respectively.1 was Hodgkin＇s lymphoma （HL）,and 23 were non Hodgkin＇s lymphoma （NHL）.Of the 23 cases of non Hodgkin＇s lymphoma（NHL）,6 were T cell NHL,17 were B cell NHL;16 Patients were 0～2 in performance status （PS）,while 7 were 3～4 in the performance status （PS）;11 had B syndrome of losing weight and having fever;Patients with mild splenomegaly were 6,moderate and highly splenomegaly were 17;11 had serum lactate dehydrogenase （LDH） elevation.Log-rank test showed that the survival time was related to age,PS,B syndrome,the level of LDH,and immunophenotyping.Cox model multivariate analysis indicated that the level of LDH and splenomegaly were not associated with overall survival.Conclusion PSL has a male dominance in this analysis,and B cell NHL are the most common histological subtypes.The histological immunophenotype,age,PS,and B syndrome were independent prognostic risk factors.T cell PSL predict a poor survival.