不同原发部位弥漫大B细胞淋巴瘤临床病理特点及预后比较

Comparison of clinical-pathological characteristics and prognosis of diffuse large B-cell lymphoma from different origins

目的 比较原发结外与结内弥漫大B细胞淋巴瘤（DLBCL）患者的临床病理特点及预后方面的差异.方法 回顾分析2007年1月至2012年12月134例DLBCL患者的临床病理特征及治疗疗效.结果 DLBCL 134例,占同期收治非霍奇金淋巴瘤（NHL）的52.14％（134/257）,结外DLBCL共93例占总体DLBCL的69.4％.结外DLBCL分期为Ⅲ～Ⅳ期者占55.9％（52/93）,结内DLBCL中Ⅲ～Ⅳ期者占75.6％（31/41）,差异有统计学意义（P=0.035）.结外DLBCL中乳酸脱氢酶升高者占33.3％（31/93）,而结内DLBCL中升高者占58.5％（24/41）,差异有统计学意义（P=0.008）.其他临床特征如出现B症状、大肿块、骨髓浸润、红细胞沉降率升高的比例及美国东部肿瘤协作组（ECOG）评分、国际预后指数（IPI）评分差异均无统计学意义（均P＞0.05）.结外与结内DLBCL生发中心及非生发中心起源出现的比例差异无统计学意义（P=0.623）.结外与结内DLBCL的3年总生存率分别为73.2％、55.2％,3年疾病无进展生存率分别为46.3％、44.1％,差异均无统计学意义（P值分别为0.065、0.748）.结论 原发结外DLBCL的发病率较高,与结内DLBCL相比其临床分期较早,肿瘤负荷较低,但两者的免疫表型、分化特征及预后无明显差异.

Objective To evaluate the difference between nodal and extra-nodal diffuse large B-cell lymphoma （DLBCL） in clinical-pathological feature and prognosis.Methods The clinical data of 134 cases of DLBCL patients were reviewed and analyzed.Results The DLBCL patients accounted for 52.14 ％ （134/257） of non-Hodgkin lymphoma of the same period and the extra-nodal DLBCL patients accounted for 69.4 ％.The proportion of stage Ⅲ/Ⅳ disease in extra-nodal DLBCL and nodal DLBCL were 55.9 ％ （52/93） and 75.6 ％（31/41）,respectively.Elevated LDH was reported in 33.3 ％ （31/93） of extra-nodal DLBCL and 58.5 ％ （24/41）of nodal DLBCL Other clinical characteristics such as B symptoms,bulky disease,elevated ESR,ECOG scores and IPI scores were not significantly different between these two groups （all P ＞ 0.05）.No difference in the frequency of GCB and non-GCB subtypes was observed between extra-nodal and nodal DLBCL （P =0.623）.The 3-year overall survival rates and 3-year progression free survival rates for extra-nodal and nodal DLBCL were 73.2 ％,55.2 ％ （P =0.065） and 46.3 ％,44.1％ （P =0.748）.Conclusions The morbidity of extranodal DLBCL is high.Primary extra-nodal DLBCL patients present early-stage disease and normal LDH more frequently than the nodal DLBCL,while no significant difference in the frequency of pathological subtypes and 3-year OS and PFS is observed between these two groups.