原发性胃肠道弥漫大B细胞淋巴瘤195例的临床特征和预后分析

Clinical characteristics and prognostic analysis of 195 primary gastrointestinal diffuse large B-cell lymphoma

目的探讨原发性胃肠道弥漫性大B细胞淋巴瘤（PGI-DLBCL）患者的临床病理特征和预后因素。方法纳入2007年1月至2014年1月初治的195例PGI-DLBCL患者，收集其临床资料，回顾性分析其临床病理特征、生存情况，以及治疗方案对预后的影响。采用Kaplan-Meier法进行生存分析。采用Log-rank检验进行单因素分析，采用Cox回归模型进行多因素分析。结果195例PGI-DLBCL患者中，男117例，女78例，中位年龄为55岁；发病部位在胃部者123例（63.1%），在肠道者64例（32.8%，其中小肠24例，回盲部19例，结直肠21例），胃肠多部位受累8例（4.1%）。184例具备完整随访资料的患者1、3和5年的累积生存率分别为81.7%、66.2%和61.0%。单因素分析显示，年龄、美国东部肿瘤协作组体能状态（ECOG PS）评分、发病部位、大包块病变、Lugano分期、国际预后指数（IPI）评分、LDH、β2微球蛋白、外周血淋巴细胞与单核细胞的绝对数比值（ALC/AMC）和低白蛋白血症为影响总生存期的预后因素。Cox回归模型多因素分析显示，胃肠多部位受累[危险比（RR）＝1.378，95%CI 1.144～1.661，P＝0.001]、Lugano分期为晚期（RR＝3.731，95%CI 1.657～8.398，P＝0.001）与ALC/AMC〈2.6（RR＝1.816，95%CI 1.055～3.127，P＝0.031）为独立的不良预后因素。手术组和非手术组的5年累积生存率分别为65.0%和53.3%，差异无统计学意义（χ^2＝2.159，P＝0.142）；联合和不联合放射治疗组的5年累积生存率分别为77.5%和58.0%，差异无统计学意义（χ^2＝3.667，P＝0.056）；加用和不加用利妥昔单克隆抗体治疗组的5年累积生存率分别为62.4%和58.6%，差异无统计学意义（χ^2＝1.352，P＝0.243）。结论胃肠多部位受累、Lugano分期较晚、ALC/AMC较低的PGI-DLBCL患者预后较差。手术和放射治疗均不能改善PGI-DLBCL患者的总生存情况。

ObjectiveTo explore the clinicopathological features and prognostic factors in patients with primary gastrointestinal diffuse large B cell lymphoma （PGI-DLBCL）.MethodsFrom January 2007 to January 2014, 195 patients with PGI-DLBCL in initial treatment were enrolled and clinical data of them were collected. Clinicopathological features, overall survival situation and the effects of therapeutic strategy on prognosis were retrospectively analyzed. Kaplan-Meier method was performed for survival analysis. Log-rank test was used for univariate analysis and the Cox proportional hazard regression model was used in multivariate factor analysis.ResultsAmong 195 patients with PGI-DLBCL （117 male and 78 female patients, median age, 55 years）, the tumors of 123 patients （63.1%） were located in stomach, 64 cases were in intestinal tract （32.8%, 24 cases in small intestine, 19 cases in ileocecum and 21 cases in colorectum） and eight cases （4.1%） had multiple gastrointestinal tract involvement. The one-year, three-year and five-year overall survival （OS） rates of 184 cases with complete follow-up data were 81.7%, 66.2% and 61.0%, respectively. The results of univariate analysis revealed that the prognostical factors affecting OS period included age, Eastern Cooperative Oncology Group performance status （ECOG PS）, lesion location, large mass lesion, Lugano staging system, international prognostic index （IPI） score, the lactate dehydrogenase, β2-microglobulin, peripheral blood absolute lymphocyte/monocyte ratio （ALC/AMC） and serum albumin levels. The multivariate analysis by Cox proportional hazard regression model indicated that multiple gastrointestinal tract involvement （relative risk （RR）=1.378, 95% confidence interval （CI）1.144 to 1.661, P=0.001）, end-stage by Lugano staging （RR=3.731, 95%CI 1.657 to 8.398, P=0.001） and ALC/AMC〈2.6 （RR=1.816, 95%CI 1.055 to 3.127, P=0.031） were the independent adverse prognosis risk factors. The five-year accumulate OS rates of surgery group and non-surgery group were 65.0% and 53.3%, respectively, and the difference was not statistically significant （χ^2=2.159, P=0.142）. The five-year accumulate OS rates of combined with and without radiotherapy group were 77.5% and 58.0%, respectively, and the difference was not statistically significant （χ^2=3.667, P=0.056）. The five-year accumulate OS rates of combined with and without rituximab treatment group were 62.4% and 58.6%, respectively, and the difference was not statistically significant （χ^2=1.352, P=0.243）.ConclusionsThe prognosis is poor in PGI-DLBCL patients with multiple gastrointestinal tract involvement, later stage of Lugano staging and lower ALC/AMC. Neither surgery nor radiotherapy could improve OS of patients with PGI-DLBCL.