原发性胃弥漫大B细胞淋巴瘤的临床分析

Clinical analysis of primary gastric diffuse large B-cell lymphoma

目的 分析原发性胃弥漫大B细胞淋巴瘤（PG-DLBCL）患者的临床特征和预后影响因素,探讨PC-DLBCL的分期系统和治疗模式.方法 回顾性分析69例PG-DLBCL患者的临床资料,以无事件生存期（EFS）和总生存期（OS）为主要研究终点.结果 全组患者的1、3和5年无事件生存率分别为83.8%、71.1%和69.0%,平均EFS为91.3个月;1、3和5年总生存率分别为91.3%、80.3%和72.4%,平均OS为98.8个月.单因素分析结果显示,改良Ann Arbor分期为ⅠE或ⅡE1期、血清乳酸脱氢酶（LDH）水平正常、血红蛋白水平正常、血清白蛋白水平正常、国际预后指数（IPI）评分为0～1分、肿瘤长径＜5 cm、浸润深度浅的患者EFS和OS显著延长（均P＜0.05）,而患者的性别、年龄、有无B症状、ECOG体力评分结果以及治疗方法与患者的预后无关（均P＞0.05）.Cox多因素回归分析结果显示,改良Ann Arbor分期、血清白蛋白水平是影响PG-DLBCL患者EFS和OS的独立因素.结论 PG-DLBCL的分期系统和各种治疗措施所处的地位仍存有争议,需进一步大样本的前瞻性研究以优化PG-DLBCL的治疗方案.

Objective To analyze the clinical features and prognostic factors of primary gastric diffuse large B-cell lymphoma （PG-DLBCL） and to evaluate the staging system and treatment modality of PG-DLBCL. Methods The clinicopathological data of 69 patients with PG-DLBCL were retrospectively analyzed. Event-free survival （EFS） and overall survival （OS） were the primary endpoints. Results The EFS rates at 1,3, and 5 years were 83.8%, 71.1%, and 69.0% , respectively, with a mean EFS of 91.3 months. The 1-, 3-, and 5-year OS rates were 91.3%, 80.3%, and 72.4%, respectively, with a mean OS of 98.8 months. Univariate analysis revealed that either EFS or OS was significantly prolonged by the following factors （P 〈0.05）： modified Ann Arbor stage ⅠE or ⅡE1 disease; normal lactate dehydrogenase（LDH） level; normal hemoglobin level; normal albumin level; International Prognostic Index （ IPI ） of 0 or 1; tumor size 〈 5 cm; and less depth of invasion. While gender, age, B symptoms at presentation,performance status and treatment modality were not significantly associated with the prognosis （ P 〉 0.05 ）.Cox regression model revealed that only modified Ann Arbor stage and albumin level were independent prognostic factors for EFS and OS. Conclusion The most accurate staging system and the exact role of different therapeutic options for PG-DLBCL are still debated. Further randomized prospective studies with a large number of patients are still needed to establish an optimal management for this disease.