肾脏弥漫大B细胞淋巴瘤患者临床特点及疗效分析

Analysis of Clinical Feature and Treatment Outcome of Patients with Renal Diffuse Large B Cell Lymphoma

目的:探讨肾脏弥漫大B细胞淋巴瘤(DLBCL)患者的临床特点及疗效。方法:回顾性分析24例肾脏DLBCL患者的临床资料,对患者临床特征及实验室指标进行分析,同时进行生存和预后因素分析。结果:肾脏DLBCL在本中心占DLBCL的发生率为5.3%,3例为原发肾脏DLBCL,21例为继发性肾脏DLBCL;24例患者中位年龄52.5岁,21例(87.5%)患者临床分期为Ⅲ-Ⅳ期,国际预后指数(IPI)评分中高危/高危20例(83.3%),12例患者(50.0%)患有3个及以上的结外器官受累。病理因素方面18例患者(75.0%)的增殖指数为KI-67≥80%。治疗总有效率为66.7%,完全缓解率为37.5%,3和5年无进展生存分别为49.5%和49.5%;3和5年总生存率分别为66.0%和49.5%。美罗华治疗组优于未使用美罗华治疗组,其3年无进展生存率为71.4%vs 30.0%;初始治疗组优于CHOP样方案治疗组,其3年PFS分别为75%vs 41.3%;化疗联合造血干细胞移植可进一步改善患者预后。单因素预后分析显示:临床分期、IPI评分、白细胞水平、血清乳酸脱氢酶(LDH)水平、白蛋白水平、是否存在有肾功能衰竭、是否存在凝血异常、结外受累器官的数目、近期疗效、KI-67水平等均为预后相关因素。结论:肾脏DLBCL临床发病率低,好发于中老年人,临床生物学特征及病理因素方面均表现为高度侵袭性,预后差。治疗方面,美罗华应用及高剂量化疗能够改善患者无进展生存率,化疗联合造血干细胞移植可进一步改善患者预后、减少复发。

Objective：To analyse the clinical feature and treatment outcome of patients with renal diffuse large B cell lymphoma（DLBCL）.Methods：The clinical data of 24 patients with renal DLBCL were collected and retrospectively analysed,the clinical features,laboratorial data,survival and prognostic factors were analysed.Results：In our center,the incidence of renal DLBCL was 5.3%in all DLBCL patients,3 cases were primary renal DLBCL and 21 cases were secondary renal DLBCL,the median age was 52.5 years,21（87.5%） patients belonged to Ⅲ and Ⅳ stage,20（83.3%） patients had high-intermediate and high risk by IPI,50%patients had more than 3 extranodal organs involvement,and the higher proliferation index（KI-67≥80%） was present in 75.0%of patients.The overall response rate（ORR） for the whole group was 66.7%,the complete response（CR） rate was 37.5%,the 3y,5-year progressionfree survival（PFS） rate was 49.5%and 49.5%,the 3y,5-year overall survival rate was 66.0%and 49.5%respectively.Rituximab could improve the survival of patients,the 3-year PFS rate was 71.4%vs 30.0%.High-dose chemotherapy was superior to CHOP-like regimens,3-year PFS was 75%vs 41.3%,and hematopoietic stem cell transplantation improved prognosis of patients.Clinical stage,IPI score,the level of WBC,LDH and albumin,the existence of renal failure and coagulopathy,the numbers of extranodal organs involvement,initial treatment outcome and the level of KI-67 were prognosis-related factors for overall survival.Conclusion：Renal DLBCL often occures in eldly men with lower incidence and poor prognosis,its clinical and pathological features are highly aggressive.Rituximab and high-dose chemotherapy can improve the survival of patients,and HSCT can further improve the survival and reduce the recurrence of patients.