弥漫性大B细胞淋巴瘤83例预后相关因素分析

Prognosis-related factors in diffuse large B-cell lymphoma

目的探讨弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)的预后相关因素。方法回顾性分析83例DLBCL患者的临床特征、免疫学分型、治疗方式及总生存期,寻找预后相关因素。结果 70例有随访资料的患者5年总生存率为52.9%。≤60岁年龄组患者总生存期显著高于>60岁年龄组;原发于胃的DLBCL(简称胃DLBCL)的总生存期显著高于其它结外或结内DLBCL;Ⅰ+Ⅱ期结外原发DLBCL预后显著好于Ⅲ+Ⅳ期,在结内原发DLBCL中,这种优势不显著;胃DLBCL的GCB亚型与非GCB亚型比例接近,其它部位的DLBCL的GCB亚型显著低于非GCB亚型;GCB亚型的预后与非GCB亚型相仿;结外病例联合利妥昔单抗(rituxima,R)化疗效果较好,对结内病例无明显改善作用;本组中预后最好的是胃DLBCL,84.6%病例均为手术切除,然而对结外非胃部病例,手术切除累及病灶疗效并未明显提高。结论与DLBCL预后相关的因素有患者年龄、原发部位及临床分期。胃DLBCL的免疫表型及临床预后均不同于其它部位的DLBCL。

Purpose To study the prognostic factors in diffuse large B-cell lymphoma （DLBCL）. Methods The clinical characteris tics, classification, therapeutic methods and the overall survival of 83 patients with DLBCL were retrospectively studied in search of prognostic factors. Results Five-year overall survival rate of 70 patients with follow-up data was 52.9%. Patients less than or equal to 60 years old had better overall survival than patients over 60 years old. Primary gastric （PG） DLBCL had better overall survival than other primary extranodal or nodal DLBCL. Stage I ＋ II primary extranodal DLBCL had better overall survival than stage III＋ IV, however, it was not obvious in nodal DLBCL. The frequencies of GCB and non-GCB subgroups were similar in PG DLBCL, whereas the frequency of GCB subgroup was significantly lower than non-GCB subgroup in other primary extranodal or nodal DLBCL. There was no difference in outcome between GCB and non-GCB subgroup. Chemotherapy including rituximab improved out- come in primary extranodal DLBCL rather than nodal DLBCL compared with chemotherapy without rituxima. Primary surgical resection was performed in eleven of thirteen （84. 6% ） PG DLBCL with the best outcome, but it did not show significant efficacy in other primary extronodal DLBCL. Conclusions Age, primary site and stage are all associated with the outcome of DLBCL. PG DLBCL has different features on immunophenotye and outcome from the DLBCL in other sites.