原发骨非霍奇金淋巴瘤26例的特点与治疗

Clinical features and treatment of primary non-Hodgkin lymphoma of bone

目的回顾分析原发骨非霍奇金淋巴瘤（PLB）的临床特点和治疗疗效，结合文献探讨其合理的治疗方法。方法收集并分析经病理证实的PLB26例的临床资料，其中放化疗综合治疗23例（88．5％），单纯化疗3例（11．5％），3例还接受过手术治疗。结果26例患者中，男性16例，女性10例，年龄8-70岁，中位年龄49岁。病理类型中，弥漫大B细胞型15例（57．7％），小淋巴细胞型1例（3．8％），B细胞来源未具体分型4例（15．5％），T细胞型5例（19．3％，其中间变大细胞型3例），未分型1例（3．8％）。Ann—Arbor临床分期ⅠE期15例（57．7％），ⅡE期和ⅢE期各3例（11．5％，11．5％），ⅣE期5例（19．3％）。全组3年和5年生存率分别为59．16％和31．37％，11例患者死亡，其中3例为接受手术切除后出现原发灶复发，9例发生其他部位侵犯。中位剂量50Gy的放射治疗未观察到放疗后骨折发生。结论PLB以骨盆较常见，病理类型以弥漫大B细胞淋巴瘤居多，临床分期Ⅰ、Ⅱ期为主，多不伴有B症状。放化疗综合治疗仍是目前主要治疗手段，放疗中位剂量50Gy较为安全可行。

Objective To analyze clinical features and treatment results of primary non-Hodgkin lymphoma of bone （PLB） and further to investigate the rational treatment. Methods Clinical data of 26 patients with PLB were analyzed. Twenty-three （88.5 %） patients received radiotherapy in combination with chemotherapy, three received chemotherapy alone, and three patients also received surgical resection. Results The pathological types of lymphoma in the patients were diffused large B-cell lymphoma （DLBCL） in 15 patients （57.7 %）, small B-cell lymphoma in 1 patient（3.8 %）, B-cell lymphoma with unclassified subtypes in 4 patients （15.5 %）, T-cell lymphoma in 5 patients （19.3 %, among which anaplastic large cell lymphoma in 3 patients）, and unclassified lymphoma in one patient （3.8 %）. Of the 26 cases of PLB, 15 were at stage Ⅰ, 3 at stage Ⅱ, 3 at stage Ⅲ, and 5 at stage Ⅳ. The 3- and 5-year overall survival rates were 59.16 % and 31.37 % respectively. In the eleven patients who died of lymphoma, three had locol-regional relapse, and nine had systemically involved lymphoma. The radiation-induced bone fracture had not been observed after local radiotherapy with median dose of 50 Gy. Conclusion Pelvis maybe a common primary site of PLB, and DLBCL type are the most observed histological subtype. The optimal treatment for PLB is radiotherapy combined with chemotherapy. Local regional radiotherapy with median dose of 50 Gy can be safe and feasible.