59例原发性胃非霍奇金淋巴瘤的临床分析

Clinical Analysis of 59 Cases of Primary Gastric Non-Hodgkin's Lymphoma

背景与目的:胃肠道是非霍奇金淋巴瘤最常侵犯的结外器官,但其标准的治疗方法目前仍未确定,本文拟通过分析有关资料,探讨原发性胃非霍奇金淋巴瘤的临床特征及治疗策略。方法:收集1980年1月至2002年1月在中山大学肿瘤防治中心收治的59例原发性胃非霍奇金淋巴瘤的临床资料,回顾性分析其临床特点和治疗方式对患者生存期的影响。结果:78.0%原发性胃非霍奇金淋巴瘤Lugano分期为Ⅰ～Ⅱ期,按工作分型78.0%病理类型为中度恶性,免疫分型以B细胞为主(占93.9%)。本组患者采用手术联合化疗37例(62.7%),单纯化疗17例(28.8%),单纯手术5例(8.5%)。总的2、5和10年生存率分别76.4%、63.7%和42.5%,其中中度恶性淋巴瘤(包括免疫母细胞淋巴瘤)手术联合化疗者与单纯化疗者5年生存率差异无统计学意义(52.5%vs.57.1%)。结论:中高度恶性原发性胃非霍奇金淋巴瘤在治疗策略上应采用化疗为主治疗模式,手术的作用尚需前瞻性随机研究进一步证实。

BACKGROUND & OBJECTIVE: Gastrointestinal tract is the most common ex tranodal involvement site of non-Hodgkin's lymphoma (NHL). However, no standard treatment regimen has ever been established for primary gastric NHL (PGNHL). Thi s paper was to summarize the clinical characteristics and treatment results of P GNHL patients. METHODS: Records of 59 PGNHL patients, treated from Jan. 1980 to Jan. 2002 in Cancer Center of Sun Yat-sen University, were reviewed to summarize their clinical characteristics, and influence of treatment modality on their su rvival. RESULTS: Of the 59 PGNHL patients, 46 (78.0%) were in stage Ⅰ/Ⅱ. Accor ding to Working Formulation, most of them were in intermediate grade (46, 78.0%) . The most common immune phenotype was B-cell lineage (46/49, 93.9%). These pati ents were treated with chemotherapy plus surgery (37,62.7%), chemotherapy alone (17,28.8%), and surgery alone (5,8.5%), respectively. The 2-, 5-, and 10-year su rvival rates of the 59 patients were 76.4%,63.7%, and 42.5%, respectively. For t hose patients in intermediate grade (including immunoblastic cell lymphoma), the re was no significant difference in the 5-year survival rate between the patient s received chemotherapy plus surgery and the patients received chemotherapy alon e (52.5% vs. 57.1%). CONCLUSIONS: Chemotherapy-dominated modality is recommended for patients with PGNHL of intermediate or high grade. The effect of surgery on PGNHL needs to be confirmed by prospective randomized trial.