216例原发胃肠道非霍奇金淋巴瘤患者病理特征与预后关系分析

Clinicopathological features and prognostic factors of 216 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（Primary gastrointestinal non—Hodgkin’S lympho—mas，PGI—NHL）患者病理特征及其与预后的关系。方法回顾性分析216例PGI—NHL患者病理特征和临床资料，采用SAS8．2统计学软件对统计数据进行X2检验、对数线性模型、COX比例风险模型及LifeTable生存分析。结果216例患者中男121例，女95例，男女比例为1．27：1，中位发病年龄56．5（8～89）岁。原发于胃147例（68．1％）、回盲部25例（11．6％）、大肠20例（9．3％）、小肠17例（7．9％）、食管及阑尾各1例（共0．9％）、5例同时累及多个部位（2．3％）。B细胞淋巴瘤182例，T细胞淋巴瘤22例，不能分类者12例。患者3年及5年总体生存率分别为69．4％和53．3％。单因素分析发现年龄〉60岁、临床分期为进展期、美国东部肿瘤协作组（ECOG）评分≥2分、LDH水平升高、国际预后指数（IPI）危险分级增加、T细胞表型、肠道发病与不良预后相关。进一步行COX回归多因素分析显示，IPI危险分级增加、T细胞表型、肠道发病为独立的不良预后因素。各治疗组中，单纯手术组患者病死率最高（64．3％，14例患者中有9例），化疗联合放疗组病死率最低（21．4％）。结论PGI—NHL以B细胞淋巴瘤为主，其整体预后好于T细胞淋巴瘤；IPI危险分级增加、T细胞表型及肠道发病为独立的不良预后因素；化疗联合放疗应作为进展期或侵袭性PGI—HNL患者的首选治疗方法。

Objective To investigate the clinicopathological features of primary gastrointestinal non-Hodgkin＇ s lymphomas （PGI-NHL） and their prognostic values. Methods The clinical and pathological data of 216 patients diagnosed as PGI-NHL from Zhejiang Cancer Hospital were analyzed retrospectively. X2 test, log-liner model analysis, COX proportional hazard regression analysis and Life-table survival analysis were used to analyze the survival status of the patients by SAS 8.2 software, and Log-rank test was performed to couple the overall survival rates with different prognostic factors. Results Totally, the age of onset was 8 to 89 years with the median age of 56.5 years. Male versus female was 1.27：1 （ 121 ： 95）. The most frequently involved location was stomach （147 cases, 68.1% ） , followed by ileocecus （25 cases, 11.6% ） , large intestine （20 cases, 9.3% ）, small intestine （17 cases, 7.9%） and multiple GI involvement （5 cases, 2.3% ）. 182 cases were classified as B cell lymphomas, 22 cases as T cell lymphomas, and 12 cases not classified exactly due to insufficient data. The 3-year and 5-year survival rates of the patients were 69.4% and 53.3%, respectively. Univariate analysis revealed that age 〉 60 years, ECOG t〉2, high LDH level, stage m - IV, IPI~〉2, T cell type and intestinal involvement were predictors for poor prognosis. IPI~〉2, T cell type and intestinal involvement were independent adverse predictors for prognosis by multiple COX proportional hazard regression analysis. Among different treatment groups, cases received chemotherapy combined with local radiotherapy gained the best survival status. Conclusions B-cell lymphoma was the main pathological type in PGI-NHL; IPI~〉2, T-cell type and intestinal involvement are independent adverse predictors for prognosis; chemotherapy combined with local radiotherapy might be the choice of approach for advanced stage and aggressive PGI-HNL.