143例霍奇金淋巴瘤的WHO分类草案应用及临床病理分析

The WHO new classification of Hodgkins lymphoma: a clinicopathological analysis of 143 patients

目的 :探讨霍奇金淋巴瘤WHO新分类的可行性 ,并且和Rye分类进行比较。 方法 :将Rye分类的 143例霍奇金淋巴瘤重新按照WHO新分类草案分型 ,比较两种分类各型的构成。所有病人均进行随访。结果 :本组男女之比为 2 3∶1。在结节硬化型中并未见到欧美文献报道的女性多于男性的情况 ;79%的病人发病年龄在 30岁以下 ;90 %病人的首发部位为颈部淋巴结。组织学分型 :结节硬化型 5 5例 (38 5 % ) ,混合细胞型 5 1例 (35 7% ) ,富于淋巴细胞的经典霍奇金淋巴瘤 17例 (12 0 % ) ,具有霍奇金淋巴瘤和大细胞间变性淋巴瘤特点的恶性淋巴瘤 8例 (5 6 % ) ,结节型淋巴细胞为主型 10例 (7 0 % )。随访 :143例中 99例有随访 (70 7% )。WHO分型中以富于淋巴细胞的典型霍奇金淋巴瘤病人的 5年存活率最高 ,达到 5 6 6 % ,其次为结节硬化型 5 5 8% ,混合细胞型 5 1 6 % ,结节型淋巴细胞为主型 40 0 % ,具有间变性大细胞淋巴瘤和霍奇金淋巴特点的恶性淋巴瘤 0。统计学分析表明 ,除Rye分型的结节硬化型和混合细胞型之间差异存在显著性 (P <0 0 5 )外 ,Rye分型的各亚型之间 ,WHO分型各亚型之间 ,以及Rye分型与WHO分型相应亚型病人的存活概率之间差异无显著性。WHO分类草案中的结节硬化型的Ⅰ级和Ⅱ级病人的存活概率之间?

Purpose To probe to the practicability of the new WHO classification of Hodgkins lymphoma(HL). Methods The HE slides of 143 cases of HL by Rye and WHO classifications. All patients were followed up. Results The male to female ratio was 2 3∶1 (99∶44). There was no predominance of female in the patients with nodular sclerosis. The age of patients ranged from 3 to 77 years and 79% of the patients was younger than 30 years. According Rye classification, there were 15 cases of lymphocyte predominance (10 5%), 35 of nodular sclerosis (24 5%), 78 of mixed cellularity (54 5%) and 14 of lymphocyte depletion (8 9%). According to WHO classification, there were 10 cases of nodular lymphocyte predominance (7 0%),55 of nodular sclerosis (38 5%, in which 8 with grade II), 51 of mixed cellularity (35 7%), 17 of lymphocyte rich classic HL (12 0%), and 8 of malignant lymphoma with features of HL and anaplastic large cell lymphoma (5 6%). There were 99 patients with data of follow up (70 7%). According Rye classification, the patients with mixed cellularity showed the best survival (5 years survival rate was 58%), than lymphocyte predominance (5 years survival was 37%), nodular sclerosis (32%) and lymphocyte depletion was worst (0). According WHO classification, the patients with lymphocyte rich classic HL showed the best survival (5 years survival rate was 56 6%), than nodular sclerosis (55 8%), mixed cellularity (51 6%), nodular lymphocyte predominance (40 0%), and lymphocyte depletion (0). But statistic analyses showed that there were no significant differences between the subtypes of Rye classification, between subtypes of WHO classification, and related subtypes between Rye and WHO classifications, except the patients with nodular sclerosis and mixed cellularity according Rye classification (P<0 05). Conclusion WHO classification is practical and reproductive. Its clinical significance will be confirmed.