非免疫抑制相关的脑原发淋巴瘤19例诊治分析

Primary Lymphoma of the Brain: A Report of 19 Immunocompetent Patients

目的:分析免疫功能正常患者脑原发淋巴瘤的临床特点、治疗和预后情况,并结合文献复习探讨其合理的治疗方式。方法:回顾性分析天津医科大学附属肿瘤医院2000年1月至2009年6月收治的19例无免疫抑制患者脑原发淋巴瘤的临床特征、治疗方式及预后因素,运用SPSS 16.0软件包进行统计分析。结果:19例患者中,男7例,女12例,中位年龄55岁。全组1、3、5年累积生存率分别为78.0%、39.7%和13.2%,中位生存期(MST)22个月;单病灶12例,多病灶7例。病理检查为B细胞来源者占94.7%(18/19),病理类型以弥漫性大细胞淋巴瘤为主。16例患者接受了手术治疗。全组共2例行大剂量甲氨蝶呤化疗。经Log-rank检验:病灶的单发或多发对生存率有显著影响(P=0.001)。结论:近年免疫功能正常人群脑原发淋巴瘤发病率上升,疗效不理想,多病灶患者预后不良。化疗在其综合治疗中极为重要,临床采用以HD-MTX为基础的化疗+放疗策略,可提高脑原发淋巴瘤患者的总体生存期。

Objective： To evaluate the clinical characteristics, treatment methods and prognosis of immunocompetent patients with primary lymphoma of the brain （PLB）, and to investigate the reasonable therapeutic regimens based on the literature. Methods： Clinical data of 19 immunocompetent patients with PLB, who were admitted to our hospital between January 2000 and June 2009, were retrospectively reviewed. The clinical characteristics, treatment and prognosis were analyzed with SPSS 16.0 statistic software. Results： Of the 19 patients, 7 were male and 12 were female, with a median age of 55 years （ range： 43 - 75 years ）. The 1-, 3-, and 5-year accumulated survival rates of the 19 cases were 8.0%, 39.7% and 13.2%, respectively, with a median survival time of 22 months. Twelve of the total patients suffered from unifocal PLB and the other 7 from multi-focal PLB. Pathologic diagnosis revealed that the cases of B-cell origin amounted to 94.7% of the total （ 18/19 ）, with diffuse large cell lymphoma most commonly seen. Sixteen of the patients underwent surgical procedures and the other 3 received stereotactic brain biopsy. High-dose methotrexate was administered in only 2 cases. Log-Rank test indicated that mode of incidence, i.e., unifocal or multi-focal lesion, had a significant effect on patient survival （ P= 0.001 ）.Conclusion： Over the past few years, there has been an increase in the incidence of PLB in immunocompetent people. The current therapeutic efficacy has not been optimistic, with an unfavorable prognosis in the patients suffering multi-focal PLB. Chemotherapy plays a very important role in the comprehensive treatment of this lymphoma. In clinical practice, chemotherapy with high-dose methotrexate as the basis plus radiotherapy can prolong the overall survival of PLB patients.