非霍奇金淋巴瘤1125例临床病理分析

The clinical and pathological analysis for 1125 cases with non-Hodgkin's lymphoma

目的 探讨修订的欧美／世界卫生组织非霍奇金淋巴瘤新分类方案的临床意义。方法 按REAL／WHO淋巴瘤分类方案，对1996年1月至2003年6月间有计划地应用含蒽环类药物为基础的联合化疗方案加或不加放射治疗所治疗的1125例NHL的临床病理特点、疗后完全缓解（CR）率、长期生存率、预后因素及其临床相关性进行了分析；同时对NHL主要病理类型的临床特点和长期生存率进行了总结。结果 本组NHL主要病理类型包括弥漫性大B细胞淋巴瘤368例（32．7％）；非特异性外周T细胞淋巴瘤137例（12．2％）；鼻腔NK／T细胞淋巴瘤110例（9．8％）；滤泡淋巴瘤98例（8．7％）；结外黏膜相关淋巴瘤69例（6．1％）；原发纵隔大B细胞淋巴瘤59例（5．2％）；B细胞小淋巴细胞淋巴瘤52例（4．6％）；T淋巴母细胞淋巴瘤51例（4．5％）；间变大细胞淋巴瘤32倒（2．8％）。全组疗后完全缓解（CR）率为62．0％，5年无病生存率和总生存率分别为46．8％与52．3％。临床分析显示，临床分期晚（Ⅲ、Ⅳ期），行为状态评分为ECOG 2～4，有全身症状，高龄（〉60岁），巨块病变（≥10．0cm），血清乳酸脱氢酶增高，结外器官受侵〉1个部位以及骨髓、胃肠道、肝、肺、中枢神经系统受侵为不良预后因素（P〈0．001）。不同NHL亚型具有独特的临床特征和长期生存率。结论 结果提示NHL新病理分类方案对NHL的分类、指导治疗和了解预后有意义，尤其是为NHL的个体化治疗提供了依据。

Objective To study the clinical significance of the Revised European - American/World Health Organization classification of the non- Hodgkin＇s lymphoma （NHL） （REAL/WHO classification）. Methods According to the new classification of NHL, 1125 patients diagnosed with NHL who were treated with the combination -chemotherapy based on containing anthrcycline with or without the radiotherapy from Jan, 1996 to July, 2003 were analysed for the clinical and pathological features, treatment response rate （complete remission, CR）, long- term survival, as well as prognostic factors. The main pathological subtypes＇ clinical characteristics were also evaluated. Results Based on the new classification, the main pathological subtypes are composed of 368 （32.7%） cases with diffuse large B- cell lymphoma （DLBCL）, 137 （12.2%） cases with peripheral T- cell lymphoma （PTCL）, 110 （9.8%） cases with nasal NK/T- cell lymphoma, 98 （8.7%） cases with follicular lymphoma （FL）, 69 cases （6. ! % ） with extranodal of mucosa - associated lymphoid tissue （MALT）, 59 （5.2%） cases with mediastinal large B - cell lymphoma, 52 cases （4.6%） for B- cell small lymphocytic lymphoma, 5 ! cases （4.5 % ） for T - lymphoblastic lymphoma, 32 cases （2.8 % ） with anaplastic large cell lymphoma （ALCL）. For the whole group, the CR is 62.0% and disease - free survival （DFS） rate and overall survival （OS） rate at five-year are 46.8% and 52.3%, respectively. The clinical analysis show that the advanced stage （stage Ⅲ or Ⅳ ）, poor performance status （ECOG 2 - 4）, B - symptom, aged （ 〉 60）, bulky disease （mass〉~ 10em）, high the serum lactate dehydrogenase （IX）H） value and the sites of extranodal involvement more than one or involved bone marrow, gastmintestine, liver, lung, central neural system （CNS） are correlated with a poor prognosis （ P 〈 0. 001 ）. Conclusion The results reveals major subtypes of NHL and the analysis shows that each pathological type has its unique the clinical characteristics, the CR rate and long- term survival rate.