根据WHO新分类对493例非霍奇金淋巴瘤的临床病理分析

Clinical and pathological reassessment of 493 cases of non-Hodgkin′s lymphomas according to current WHO classification of lymphoid neoplasms

目的 探讨非霍奇金淋巴瘤 (NHL)的临床病理特点,评价世界卫生组织 (WHO) 2001淋巴瘤新分类标准的实用性。方法 复查 1992—2003年 500例既往经病理诊断为NHL的病例,观察其形态学、免疫学及临床特点,按WHO新分类标准进行重新定性和分类,对其中 156例有随访的病例进行生存率分析。结果 500例中, 493例NHL,其中B细胞肿瘤 69. 0%,T和NK细胞肿瘤29. 8%;前六位最常见类型为弥漫大B细胞淋巴瘤(DLBCL)、滤泡性淋巴瘤(FL)、非特殊型周围T细胞淋巴瘤(PT- un)、T淋巴母细胞淋巴瘤(T- LBL)、MALT型结外边缘区B细胞淋巴瘤(MALT)及B -小淋巴细胞性淋巴瘤(B -SLL);青少年中最常见为LBL、DLBCL及Burkitt淋巴瘤。在本组病例中,LBL在所有患者尤其是青少年患者中的比例均明显高于国外报道,FL的比例明显高于国内报道。不同类型NHL的生存情况在总体上差异有统计学意义(P<0. 001),其中边缘区B细胞淋巴瘤(MZL)与SLL的预后最佳,LBL与PT- un的预后最差,DLBCL与FL介于前两组之间。按WHO推荐的两种方法划分的FL不同级别之间,生存情况差异无统计学意义 (P>0. 05)。结论 淋巴瘤WHO2001新分类实用性强、便于掌握,各亚型的形态学、免疫学指标可靠,结合临床能较好应用于淋巴瘤的诊断和预后。但是,建议国内同行对FL的判断及分级标准?

Objective To investigate the clinical and pathological features of non-Hodgkin′s lymphoma (NHL) and to evaluate the applicability of the new WHO classification of lymphoid neoplasms. Methods According to the new WHO classification, a total of 500 cases of non-Hodgkin′s lymphoma diagnosed during the period 1992—2003 were reviewed and reappraised with their morphological, immunological and clinical characteristics. Clinical survival analysis was performed in 156 cases that accompanied with follow-up data. Results Among 500 cases previously diagnosed as lymphomas, 493 cases (98.6%) were confirmed to be NHL, of which B-cell neoplasms was 69.0% and T/NK-cell neoplasms 29.8%. Overall, 6 subtypes including diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), unspecified peripheral T-cell lymphoma (PT-un), precursor T-lymphoblastic lymphoma (T-LBL), extranodal marginal zone B-cell lymphoma of MALT type (MALT) and B-small lymphocytic lymphoma (B-SLL) were among the most common subtypes. In pediatric and young patient populations, the most common subtypes were LBL, DLBCL and Burkitt′s lymphoma. The frequency of LBL in all patients, especially in the juniors, was much higher than those reported outside China's Mainland, and the frequency of FL was much higher than the reported in China's Mainland. The frequency of FL was much higher than the reported in China's Mainland. Clinical survivals among different histological subtypes of NHL varied considerably with statistic significance (P<0.001). Marginal zone B-cell lymphoma and SLL demonstrated the best prognosis, LBL and PT-un both the worst, whereas DLBCL and FL had an intermediate prognosis, however, subgrouping of FL according to WHO classification did not reveal a significant survival difference (P>0.05). Conclusions Basing upon the results of a comprehensive survey on the morphologic features, immunophenotyping and clinical data of the above cases, the new WHO classification of lymphoid neoplasms is practical and easily applicable for routine pathological evaluation of lymphoproliferaive disorders and in guiding the clinical management. It appears that the diagnostic and grading criteria for FL in China's Mainland need to be re-evaluated.