31例原发性骨淋巴瘤的临床特点及疗效分析

Clinical characteristics and outcomes of 31 patients with primary bone lymphoma

目的分析原发性骨淋巴瘤（PBL）的临床特点、治疗效果及影响预后的因素。方法回顾性分析1992~2010年南方医院收治的31例PBL患者的临床资料,采用Kaplan-Meier法及Cox比例风险模型进行生存及预后因素分析。结果中位年龄46岁,最常见的发病部位为股骨（29%）和脊柱（29%）。16例（52%）化疗联合放疗治疗,15例（48%）单独化疗,中位随访49个月,总体有效率为94%（完全缓解68%;部分缓解26%）。中位总生存期（OS）为71（95%CI：36~106）月,中位无进展生存期（PFS）为47（95%CI：30~64）月。单因素分析提示使用美罗华、放疗及国际淋巴瘤预后指数（IPI）0-2分提高OS与PFS,多因素分析提示是否使用美罗华、IPI评分为OS的独立预后因素,是否使用美罗华、IPI评分、是否联合放疗为PFS的独立预后因素。结论使用美罗华显著提高PBL患者的OS及PFS,放疗对PBL患者OS无显著影响,但提高PFS。

Objective To investigate the clinical characteristics, outcomes and prognostic factors of primary bone lymphoma （PBL）. Methods We retrospectively analyzed 31 consecutive patients with the diagnosis of PBL initially treated at our hospital between 1992 and 2010. Kaplan-Meier method was used for survival analysis and Cox regression model used for analyzing the prognostic factors. Results The median age of the patients was 46 years. The most common sites of involvement were the femur （29%） and the spine （29%）. Sixteen （52%） patients underwent chemoradiotherapy, and the other 15 （48%） received chemotherapy. With a median follow-up of 49 months, the patients showed an overall response rate of 94% （including a complete response rate of 68% and a partial response rate of 26%）. The median overall survival （OS） of the patients was 71 months （95% CI： 36-106 months） with a median progression-free survival （PFS） of 47 months （95% CI： 30-64 months）. Univariate analysis identified the use of rituximab, radiotherapy, and an international prognostic index （IPI） score of 0-2 as the favorable prognostic factors for OS and PFS. Multivariate analysis showed that the use of rituximab and IPI score were independent prognostic factors of the OS and PFS, and radiotherapy was the predicting factor for PFS but not for OS. Conclusion The use of rituximab can improve the OS or PFS of patients with PBL, and radiotherapy offers additional benefits for PFS but not for OS.