50例T细胞非霍奇金淋巴瘤的临床分析

Clinical analysis of 50 patients with T-cell non-Hodgkin's lymphoma

背景与目的:T细胞非霍奇金淋巴瘤(T-cell non-Hodgkin’s lymphoma,T-NHL)在亚洲国家相对高发,且其发病具有种族及地域特征。本研究旨在讨论新疆医科大学第一附属医院收治的T-NHL患者的发病特点、病理类型及生存情况。方法:收集2002年1月—2012年12月本院诊治的50例T-NHL患者,对发病特点、病理类型及生存情况进行分析。结果:T-NHL患者汉族37例,维吾尔族13例;最常见病理类型为结外NK/T细胞淋巴瘤(NK/T cell lymphoma,NK/TCL),共16例(32%)。儿童组患者病理类型均为T淋巴母细胞性白血病/淋巴瘤(T-lymphoblastic leukemia/lymphoma,T-LBL),青年组及中年组最常见类型为NK/TCL,老年组最常见类型为血管免疫母细胞性T细胞淋巴瘤(angioimmunoblastic T-cell lymphoma,AITL)。临床分期Ⅰ、Ⅱ期患者均为NK/TCL,Ⅲ、Ⅳ期患者最常见为周围T细胞淋巴瘤-非特指性(peripheral T-cell lymphomas-unspecified,PTCL-U)及AITL。汉族与维吾尔族患者最常见的病理类型分别为NK/TCL及T-LBL。全组患者的5年总生存率为39%。NK/TCL、间变性大细胞性淋巴瘤(anaplastic large cell lymphoma,ALCL)、AITL、PTCL-U和T-LBL的3年总生存率分别为71%、61%、53%、19%和7%(P<0.05);中年组、青年组、老年组和儿童组5年生存率分别为67%、35%、21%和0(P<0.05)。结论:新疆地区T-NHL可能具有独特的临床特征:总发病率与国内报道相似,高于国外报道,汉族发病率高于维吾尔族;病理类型构成与欧美国家存在较大差异;不同年龄组、分期及民族的病理类型分布存在显著差异。长期生存率低、不同病理类型及年龄组均是影响生存的重要因素。

Background and purpose：T-cell non-Hodgkin’s lymphoma（T-NHL） has relatively high incidence in Asian countries, and the incidence rate showed an upward tendency. It has a dual characteristic of both ethnic and regional. We conducted this study in order to analyze the clinical characteristics, pathological type and survival of T-NHL in our hospital. Methods：Records of 50 cases with T-NHL treated from Jan. 2002 to Dec. 2012, were analyzed in terms of clinical characteristics, distribution of pathological type and survival. Results：Patients with T-NHL account for 24%of NHL cases in our study. Of the 50 cases, 37 were Han, 13 were Uygur;The most frequent type was NK/T cell lymphoma（NK/TCL）（16/50, 32%）. We performed pathological type for each age group：4 cases with children’s group were all T-lymphoblastic leukemia/lymphoma（T-LBL）（4/4,100%）, the most frequent type of youth and middle age group was NK/TCL（8/20, 40%;7/13, 53.8%）, as the senile group was angioimmunoblastic T-cell lymphoma（AITL）（6/13, 46.2%）. There was also a signiifcant difference in pathological type between the stage, with stageⅠ-Ⅱwere all NK/TCL（12/12, 100%）, stageⅢ-Ⅳwere observed with peripheral T-cell lymphomas-unspeciifed（PTCL-U）（9/38, 23.7%） and AITL（9/38, 23.7%）. The frequent type of Han was NK/TCL（14/37, 37.8%）, as the Uygur was T-LBL（5/13, 38.5%）. The median overall survival（OS） time was 12 （ranged 0-112） months. The 5 year OS rate was 39%. Both pathological type and age group were important factors influencing survival. The difference in outcome for the pathological type（P〈0.05）： NK/TCL and anaplastic large cell lymphoma（ALCL） had the better 3 year OS rates（71%, 61%）, but PTCL-U and T-LBL had poor prognosis（19%, 7%）. Age did a signiifcant effect on OS（P〈0.05）：children’s group had the worse 5-year OS rate （0%）, middle age group had a better prognosis （67%）, the OS of the youth group was 35%, for the senile group was 21%. Conclusion：T-NHL in Xinjiang region have their unique clinical characteristics：The overall incidence rate was similar with the domestic report, however, higher than the reports abroad. The incidence of Han was higher than Uygur. Pathological type showed in this study was different from that in European and American countries. There was a significant difference in distribution of pathological type in different age group, stage and nation. The long-term survival and prognosis of patients in Xinjiang region was poor. Both pathological type and age group were important factors inlfuencing survival.