90例粘膜相关淋巴瘤患者的临床预后分析

Clinical features and prognosis of mucosa-associated lymphoid tissue lymphoma: a report of 90 cases

背景与目的:粘膜相关淋巴瘤是一种边缘带非霍奇金淋巴瘤,由于其惰性的临床过程,对其临床特点及预后因素的报道比较少见。本研究对该肿瘤的临床特点及预后因素进行探讨。方法:收集1997年12月至2007年2月经病理确诊的粘膜相关淋巴瘤病例共90例,分为胃组和胃外组进行回顾性分析。结果:全组90例患者中,中位年龄52岁(13～77岁),原发于胃的23例(25.6%),胃外67例(74.4%)临床分期为Ⅰ～Ⅱ期的75例(83.3%),Ⅲ～Ⅳ期15例(16.7%)多器官累及的患者占34.4%,淋巴结累及的患者占44.4%,原发胃外的患者更易出现淋巴结转移(P=0.040)。经治疗后完全缓解率为72.1%。中位随访时间31.4个月,淋巴结阳性和阴性患者的5年生存率分别为58.7%和88.4%(P=0.012),IPI评分0～2分和首次治疗后完全缓解的患者中位无进展时间分别为61.9个月和未达到,而IPI评分>2分和首次治疗未达完全缓解的患者中位无进展时间分别为5.2个月和15.0个月,结果差异具有统计学意义(P=0.005和P=0.030)。在67例胃外组患者中,IPI评分是总生存的独立预后指标(P=0.023)。结论:粘膜相关淋巴瘤应被认为是一种广泛播散的惰性淋巴瘤,原发胃外的患者更易出现淋巴结侵犯。具有不良预后因素包括淋巴结侵犯,IPI评分>2和首次治疗疗效未达到完全缓解的患者应给予更加积极的治疗。

Background and Objective. Mucosa-associated lymphoid tissue lymphoma is a histological type of marginal zone non-Hodgkin＇s lymphoma （NHL）. Its clinical features and prognosis have seldom been reported because of its indolent clinical course. This study was to explore the clinical features and prognosis of this disease. Methods. Clinical data of 90 pathologically confirmed mucosa-associatecl lymphoid tissue lymphoma patients, treated from December 1997 to February 2007, were analyzed. Results： Of the 90 patients, 23 （25.6%） had gastric lymphoma and 67 （74.4%） had non-gastric lymphoma, with a median age of 52 （range, 13- 77）; 75 （83.3%） had stage Ⅰ-Ⅱdisease and 15 （16.7%） had stage Ⅲ-Ⅳ disease; 31 （34.4%） had multiple organ involvement and 40 （44.4%） had nodal involvement. The percentage of nodal involvement was significantly higher in non-gastric group than in gastric group （P=0.040）. The complete remission （CR） rate after treatment was 72.1%. The patients were followed up for a median of 31.4 months. The 5-year overall survival rates of patients with and without nodal involvement were 58.7% and 88.4%, respectively （P= 0.012）. The median time to progression was significantly longer in patients with IPI score of 0-2 than in those with IPI score of 〉 2 （61.9 months vs. 5.2 months, P=0.005）, and was significantly longer in patients who got CR after initial treatment than in those without CR （not reached vs. 15.0 months, P=0.030）. In non-gastric lymphoma group, IPI score was an independent prognostic variable of overall survival （P=0.023）. Conclusions. Mucosa- associated lymphoid tissue lymphoma should be considered as a kind of disseminated indolent lymphoma. The patients with non-gastric lymphoma are likely to have nodal involvement. Patients with poor prognostic factors should be treated more aggressively.