胃淋巴瘤临床病理分析

A clinicopathological analysis of gastric lymphoma

目的探讨胃淋巴瘤的临床病理特点及预后相关因素。方法结合2001年版WHO关于淋巴造血组织肿瘤的分类标准,回顾83例胃淋巴瘤临床及病理资料,对其中78例进行随访,随访时间5～192个月。对临床病理特征及治疗方式等多种因素与生存率进行比较分析。结果(1)临床表现:临床症状以腹痛最多见,83例胃淋巴瘤中有60例(72%);39例(47%)有B症状(发热、盗汗、消瘦);21例(25%)有长期慢性胃病史;胃肠黏膜多部位病变13例(16%);淋巴结受累51例(61%)。(2)组织学类型:黏膜相关淋巴组织结外边缘区B细胞淋巴瘤(MALT淋巴瘤)为57例(69%),弥漫大B细胞淋巴瘤合并MALT淋巴瘤23例(28%),弥漫大B细胞淋巴瘤2例(2%),滤泡性淋巴瘤1例(1%)。(3)临床分期与生存率:临床ⅠE期31例,ⅡE期38例,ⅢE期8例,Ⅳ期6例。总5年和10年生存率分别为77.8%和70.1%,平均生存期146个月。MALT淋巴瘤的5、10年生存率分别为77.4%和72.3%,弥漫大B细胞淋巴瘤合并MALT淋巴瘤的5、10年生存率分别为81.8%和68.2%,弥漫大B细胞淋巴瘤的5年生存率为50.0%。结论胃淋巴瘤患者无特异临床症状。MALT淋巴瘤是最常见的病理组织学类型。胃淋巴瘤病变可长期局限,预后较好。患者生存率与淋巴结受累、临床分期密切相关,与发病年龄、性别、有无B症状、病变深度及范围和治疗方式等因素均不相关。

Objective To discuss the clinicopathological features and prognostic factors of gastric lymphoma. Methods 83 gastric lymphoma cases were analyzed retrospectively in accordance to the criteria of the new World Health Organization classification for neoplastic diseases of the hematopoietic and lymphoid tissues. The correlations between clinicopathological features, therapeutic measures and survival were discussed. Results The age of patients ranged from 25 to 77, with a median of 52. The number of males were similar to that of females. There were no specific symptoms. The most common symptoms were stomachache(60 cases,72%)or discomfort. The duration of symptoms was often long and with a history of chronic gastric diseases (21cases, 25%). 13 cases had multiple lesions in the gastrointestinal mucosa. 51 cases (61%) were accompanied by lymph node involvement. According to the new World Health Organization classification for neoplastic diseases of the hematopoietic and lymphoid tissues, 57 cases were extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT)-type (MALT lymphoma), 23 were diffuse large B cell lymphoma accompanying MALT lymphoma, 2 were diffuse large B cell lymphoma and 1 was follicular lymphoma. Of all the cases, 31 were stage ⅠE, 38 stage ⅡE, 8 stage ⅢE and 6 stage Ⅳ by the Ann Arbor staging system (1972). The total 5-year and 10-year survival rates were 77.8% and 70.1% respectively, with the mean survival time of 146 months. The 5-year and 10-year survival rates of MALT lymphoma were 77.4% and 72.3%, the 5-year and 10-year survival rates of diffuse large B cell lymphoma accompanying MALT lymphoma were 81.8% and 68.2%, the 5-year survival rate of diffuse large B cell lymphoma was 50.0%. Conclusions There are no specific symptoms in gastric lymphoma patients. Extranodal marginal zone lymphoma of MALT-type is the main histopathological type of gastric lymphoma, often accompanied by multiple mucosa involvement and also often accompanied by a history of chronic gastric disease. The lesion is usually localized for a long time, with a very good prognosis. Survival rate has a significant correlation with lymph node involvement and clinical stage. No correlations were found between the survival rates with age, gender, B symptoms, invasive depth of the wall of stomach, the size and range of the tumors or different therapeutic measures.