90例原发胃肠道黏膜相关淋巴组织结外边缘区B细胞淋巴瘤患者临床特征与预后分析

Clinical characteristics and prognostic analysis of 90 patients with primary gastro-intestinal marginal zone lymphoma

目的 了解原发胃肠道黏膜相关淋巴组织结外边缘区B细胞淋巴瘤（MALT淋巴瘤）患者临床特征及预后情况.方法 回顾性分析90例原发胃肠道MALT淋巴瘤患者资料,对患者临床特征和相关预后因素进行分析.结果 90例患者中胃内起病者78例,非胃内起病者12例.国际预后指数（IPI）评分0～2分者80例,3～5分者10例.与胃内起病者比较,非胃内起病者多为IPI 3～5分的高危患者（7.7％对33.3％,P=0.025）、幽门螺旋杆菌（Hp）感染率显著降低（50.0％对87.2％,P＜0.01）.IPI评分0～2分的低危患者可选择抗Hp治疗、手术、放疗及化疗等治疗,其中化疗可提高患者无进展生存（PFS）率.接受化疗的高危患者3年总生存（OS）率达100.0％.单因素分析结果显示,ECOG评分（P=0.006）、Musshoff分期（P=0.008）、IPI评分（P=0.000）、LDH水平（P=0.019）和是否接受化疗（P=0.026）是影响患者PFS率的相关因素.多因素分析结果显示IPI评分（3～5分）（OR=8.325,95％ CI 3.171～21.853,P=0.000）和是否接受化疗（OR=0.319,95％CI0.121～0.838,P=0.020）是影响患者PFS率的独立预后因素,ECOG评分（≥2分）是影响患者OS率的独立预后因素（OR=5.092,95％CI1.005～25.788,P=0.049）.结论 原发胃肠道MALT淋巴瘤是一种低度恶性的淋巴瘤,以低危患者多见,多数患者可获得长期生存.低危患者可选择放疗或抗Hp治疗作为起始治疗方案,高危患者应选择化疗.

Objective To evaluate the clinical characteristics and prognostic factors of patients with primary gastro-intestinal marginal zone lymphoma （MALT）.Methods Retrospective aualysis was performed in 90 patients diagnosed with primary gastro-intestinal MALT lymphoma clinical characteristics and survival analyses.Results Among 90 patients,78 cases were originated from the stomach and 12 cases with extra-gastric origin.Eighty patients were classified as low-risk （IPI score 0-2）,and 10 patients high-risk （IPI score 3-5）.Compared to gastric MALT patients,extra-gastric cases presented with higher IPI score （7.7% vs 33.3%,P=0.025） and higher Hp infection rate （50.0% vs 87.2%,P〈0.01）.Treatment options for low risk patients （IPI score 0-2） included Hp eradication,surgery,radiotherapy and chemotherapy.Chemotherapy could improve progression-free survival （PFS） in low-risk patients.For high-risk patients,those receiving chemotherapy had 100% 3-year overall survival （OS）.Univariate analysis revealed that ECOG （P=0.006）,Musshoff staging （P=0.008）,IPI score （P=0.000）,elevated LDH （P=0.019） and chemotherapy （P=0.026） were correlated with PFS.Multivariate analysis showed that higher IPI score （IPI 3-5） （OR=8.325,95% CI 3.171-21.853,P=0.000） and chemotherapy （OR=0.319,95% CI 0.121-0.838,P=0.020） were independent prognostic factors for PFS.ECOG （≥2） was independent prognostic factor for OS（OR=5.092,95%CI 1.005-25.788,P=0.049）.Conclusion Primary gastro-intestinal MALT lymphoma was an indolent subtype of non-Hodgkin＇ s lymphoma.Patients usually had low risk IPI and achieved long-term survival.Frontline therapy for low-risk patients was radiotherapy or Hp eradication,and chemotherapy for high-risk ones.