原发乳腺非霍奇金淋巴瘤的预后分析

Prognosis of primary non-Hodgkin＇s lymphoma of the breast

目的分析原发乳腺非霍奇金淋巴瘤（PNHLB）的临床特点与预后。方法回顾性分析45例PNHLB的临床特点。5例行乳房改良根治术，5例行患侧乳房单纯切除术。43例行CHOP或CHOP样联合化疗，其中6例加用利妥昔单抗。19例化疗后行局部放疗，1例仅行单纯放疗。45例患者均获随访，随访时间6～180个月。结果45例PNHLB患者中，弥漫大B细胞性淋巴瘤（DLBCL）37例，T细胞型淋巴瘤4例，黏膜相关淋巴组织样淋巴瘤（MALT）4例。一线化疗的有效率为90．7％。中位总生存期（OS）为6．82年，中位无进展生存期（PFS）为4．25年。Cox比例风险模型分析结果显示，IPI（RR=5．682，P=0．002）、AnnArbor分期（RR=1．836，P=0．040）是PNHLB患者OS的独立影响因素，中枢神经系统浸润（RR=1．107，P=0．005）是PFS的独立影响因素。结论国内PNHLB发病年龄较早，以DLBCL最常见。IPI和AnnArbor分期是PNHLB患者预后的独立影响因素。

Objective To analyze the clinical characteristics and prognosis of primary non-Hodgkin＇s lymphoma of the breast （PNHLB）. Methods The characteristics, treatment methods and outcomes of 45 patients with PNHLB were retrospectively analyzed. Chemotherapy including CHOP and CHOP-like regimens was administered in 43 patients, and monoclonal antibody therapy in 6 patients. Furthermore, 19 patients underwent radiotherapy after chemotherapy. Results Of these 45 patients, 37 patients had diffuse large B cell lymphoma （DLBCL）, patients with T cell or mucosa-associated lymphoid tissue （MALT） lymphoma were 4, respectively. Overall response rate of first-line chemotherapy was 90.7%. Median overall survival （OS） and progression-free survival （ PFS ） of all patients was 6.82 and 4.25 years, respectively. The results of Cox regression model analysis showed that international prognostic index score （IPI） （ RR = 5. 682, P = 0. 002） and Ann Arbor stage （RR = 1. 836, P = 0.040） were negative independent prognostic factors for OS. Central nervous system involvement （ RR = 1,107, P = 0. 005 ） was a negative independent prognostic factor for PFS. Condusion The patients with PNHLB have early occurrence in lifespan. Most pathologic type was DLBCL, IPI and Ann Arbor stage are two independent prognostic factors for survival.