21例原发性乳腺非霍奇金淋巴瘤临床分析

Primary Breast Non-Hodgkin Lymphoma: A Report of 21 Cases

目的:分析原发性乳腺非霍奇金淋巴瘤(PBNHL)的临床特征、治疗与预后,增加对该罕见病的认识。方法:回顾性分析1985年1月～2003年12月本院21例PBNHL的临床特点、治疗经过和随访结果。结果:21例PBNHL,女20例,男1例,中位年龄36岁(21～84岁)。90%AnnArbor分期为Ⅰ～Ⅱ期,所有患者预后分级均为低危或低中危。病理类型B细胞性87%,外周T细胞性13%。弥漫大B细胞性占53%。8例接受乳腺癌根治术或改良根治术,13例为肿块切除或活检;20例患者接受CHOP方案化疗;4例于化疗后局部放疗。患者双侧乳腺同时或先后发病占33%(7/21),CNS受累比例为14%。随访时间3～116月,中位17个月。中位总生存期和无事件生存期为26个月和12个月,5年总生存率和无事件生存率为39%和19%。结论:PBNHL病理以弥漫大B细胞性最常见,低度恶性NHL少见。CNS侵犯或复发是PBNHL的重要特征,对侧乳腺复发是接受患侧乳腺癌根治术或放疗的患者治疗失败的首要原因。中高度恶性PBNHL治疗可采用乳腺局部切除加全身化疗和乳腺放疗,宜接受中枢预防治疗,应密切监测对侧乳腺病变,及时治疗。

Objective： To evaluate the clinical characteristics, case history, efficacy and prognosis of primary breast non-Hodgkin lymphoma （PBNHL）. Methods： the patient characteristics, treatment methods and outcome of 21 cases of PBNHL patients seen at cancer center of Sun Yat-sen University during 1985-2003 were analyzed retrospectively. Results： There were 21 cases of PBNHL, including 20 females and 1 male; the median age is 36, from 21 to 84 years）, with 18% low-grade NHL, 71% intermediate-grade NHL and 13% T-cell NHL. 90% of the cases were at stage Ⅰ/Ⅱ. Eight patients underwent mastectomy and 13 had local excision or biopsy. Chemotherapy was given to 20 patients. Four patients received radiation after chemotherapy. 14% of the patients developed CNS infiltration. There were bilateral breast involved in 33% of the patients. The median follow-up was 17 months （range 3- 116 months）. Five-year overall survival （OS） rate and event-free survival （EFS） rate was 39% and 19%. The median OS was 37 months for those treated with mastectomy or radiation, compared to 17 months for those without mastectomy or radiation （P=0.19）, and the EFS was 21 months, compared to 4 months, respectively （P=0.06）. Conclusion： The prognosis of PBNHL is poor. Mastectomy has a better local control, but can be replaced by local excision followed by breast radiation. Chemotherapy is indispensable in intermediate or high-grade PBNHL. CNS prophylaxis is valuable and followed-up closely for the signs of contralateral breast relapse was necessary.