23例儿童霍奇金淋巴瘤临床分析(英文)

Clinical Analysis of 23 children with Hodgkin Lymphoma

目的:分析儿童青少年霍奇金淋巴瘤(HL)患者的病理特征、临床表现及其预后影响因素。方法:收集青岛大学医学院附属医院血液儿科2001年5年至2013年8月收治的23例经病理确诊的儿童青少年HL患者的临床资料,采用Fisher确切概率法等进行各组间差异检验。结果:确诊病例共23例,中位年龄7.5岁,男:女发病比例=6.7:1,Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期分别占13.0%、26.2%、30.4%、30.4%;结节性淋巴细胞为主型(NLPHL)1例(4.3%),经典型HL22例(95.7%):混合细胞型(MC)10例(43.5%),淋巴细胞为主型(LP)11例(47.9%),结节硬化型(NS)1例(4.3%);受累部位以颈部淋巴结最多见,其次依次为纵隔、腹腔及腹膜后、脾、骨骼、肺组织等,其中巨大纵隔肿块者2例;具有B症状者8例(34.7%)。化疗2个疗程评估总有效率为100%,完全缓解(CR)率69.6%,部分缓解(PR)率30.4%。Ⅰ期和Ⅱ期患者CR率100%,明显高于Ⅲ期和Ⅳ期患者(50%),P<0.05;23例患者7例复发,复发率Ⅲ期和Ⅳ期患者为46.2%,Ⅰ期和Ⅱ期患者为11.1%,前者高于后者(P=0.0098);有B症状与无B症状患者之间复发率有显著统计学差异(P=0.019);2例有巨大包块患者皆复发;各病理分型与疾病的复发间差异无统计学意义(x2=2.695,P>0.05)。结论:儿童霍奇金淋巴瘤预后相对较好,但Ⅲ期和Ⅳ期、合并B症状及大肿块或大纵隔肿瘤的患者复发率高,应依据疾病危险度分层治疗,以期更好的预后。

Objective： To investigate the pathological characteristic, clinical features and prognosis in children and adolescent with Hodgkin＇s lymphoma. Methods： 23 patients of childhood and adolescent with Hodgkin＇s lymphoma were treated in department of pediatric Hematology of the affiliated Hospital of Qingdao university from 2001 to 2013. The clinicopathological and follow-up data of the patients were retrospectively reviewed. The clinical rate in the difference of groups was analyzed by x2test and fisher exact test. Results： 23 cases were diagnosed in the study. The mean age was 7.5 years. The sex-ratio was 6.7：1. Stage I, II, III and IV were accounted for 13.0%, 26.2%, 30.4%, 30.4% respectively. There was 1 patient of NLPHL（4.3%）, 10 patients of MC（43.5%）, 11 patients of LP（47.9%） and 1 patient of NS（4.3%）. The involved parts were mostly the cervical lymph node, followed by mediastinum, enterocoelia, retroperitoneal, spleen, skeleton and lung tissue, of which there were 2 patients with huge mediastinum mass. 8 patients had B symptoms（34.7%） at diagnosis. After 2 cycles of initial chemotherapy, the overall response rate（ORR） reached 100%. And complete response（CR） rate was 69.6% while partial response（PR） rate was 30.4%. The CR rate of patients at stage I and II（100%） was significantly higher than that at stage III and IV（50%）, P〈0.05. 7 of 23 patients were relapsed. The recurrence rate of stage III and IV was higher than that at stage I and II（46.2% verse 11.1%,P=0.0098）. For the recurrence rate of patients, there was significantly statistical difference between patients with B symptoms and those without B symptoms（P=0.019）. 2 patients with mediastinal neoplasm were relapsed. There was no statistical difference between the relapse of disease and each histological subtype（x2=2.695, P〈0.05）. Conclusions： The prognosis of children and adolescent with Hodgkin＇s lymphoma is better, but the patients of stage III and IV or ones with B symptom and huge mediastinal lump have higher recurrence rate. The hierarchical therapy is adopted for children with HL in order to reach the long-term survival.