110例原发胃肠道非霍奇金淋巴瘤临床特征与预后分析

Analysis of clinical characteristics and prognostic factors of 110 cases with primary gastrointestinal tract non-Hodgkin＇ s lymphoma

目的探讨原发胃肠道非霍奇金淋巴瘤（PGI-NHL）的病理分型、预后因素和有效的治疗方式。方法回顾性分析我院110例PGI-NHL患者的临床资料，分析预后相关因子及各种治疗方式的疗效。结果110例患者男女比例1．56：1，中位发病年龄58．5岁。发病部位以胃为主，其次为小肠。弥漫大B细胞淋巴瘤（DLBCL）和黏膜相关淋巴组织淋巴瘤（MALT）是主要类型。可追踪病例75例，5年累积生存率62％，中位生存期36个月。单因素预后分析显示胃与肠道的NHL预后相似（P〉0．05），MALT型预后好于DLBCL型（P=0．003）。PGI—DLBCL中生发中心（GC）与non—GC的比例为1：2．82。3种主要的治疗方式中手术联合化疗与单纯手术、单纯化疗相比病死率最低。疾病进展死亡占总病死率的51．7％。结论本组PGI—DLBCL患者中non—GC比例升高，5年总体生存率较DLBCL总体生存率低；治疗应首选联合化疗，手术仅用于局部并发症的治疗及对巨块型病变的控制；系统性治疗后的患者仍需巩固维持治疗。

Objective To explore the pathologic types, prognostic factors and effective treatment of PGI-NHL. Methods Clinical data of 110 PGI-NHL patients were analyzed retrospectively, and so did prognostic factors and each treatment outcome. Results Of the 110 patients, the male-female ratio was 1.56：1 with a median age of 58.5 years. Stomach was the most common site and small intestine was the second. The main histological subtypes were diffuse large B-cell lymphoma（DLBCL） and mucosa-associated lymphoid tis- sue （MALT） NHL. Among the 75 patients followed up, the 5-year overall survival（OS） rate was 62%, the median survival time was 36 months. Univariate analysis showed a similar prognosis between PG-NHL and primary bowel NHL （P 〉 0. 05 ）, and PGI-MALT had better prognosis than PGI-DLBCL. Among PGI- DLBCL, the ratio of germinal center（GC） sub-type to non-GC was 1： 2.82. Among three main treatments, chemotherapy combined with surgery had the lowest mortality rate, compared with each alone. Disease pro- gress mortality was 51.7% of overall mortality. Conclusion The percent of non-GC in PGI-DLBCL is higher than that of in nonPGI-NHL. The 5-year OS rate is lower than the 5-year OS rate of DLBCL. Combined chem- otherapy is the first line treatment. Surgery is important in the control of the complications of GI tract. Mainte- nance treatment is important even in those who had systemic treatments.