原发鼻腔B细胞淋巴瘤临床特征及治疗分析

Clinical features and treatment of primary nasal B-cell lymphoma

目的 探讨原发鼻腔B细胞淋巴瘤（PNBCL）的临床特点及治疗方法.方法 回顾分析2009年1月至2015年6月经病理证实的18例PNBCL的临床资料,对其临床表现、影像学特征、病理类型及治疗进行分析.结果 PNBCL临床多表现为鼻塞、流涕.18例患者年龄12~76岁,中位年龄51岁,男女比例为11：7;Ann Arbor分期ⅠE~ⅡE期15例,ⅢE~Ⅳ期3例;弥漫大B细胞淋巴瘤13例,套细胞淋巴瘤3例,伯基特淋巴瘤2例;血清乳酸脱氢酶增高4例;有B症状1例.CT检查示鼻腔异常软组织影,多位于单侧,可呈轻-中度均匀强化.18例患者中1例放弃治疗,14例接受单纯化疗,3例接受放化疗,治疗总有效率为82.3%（14/17）.随访结束死亡5例,3年总生存率为54.5%（6/11）.结论 PNBCL患者ⅠE~ⅡE期多见,B症状少见,病理分型中弥漫大B细胞淋巴瘤最多见.目前PNBCL的治疗首选化疗,可辅助放疗,但预后欠佳,化疗方案仍需进一步改进.

Objective To study the clinical characteristics and treatment of primary nasal B-cell lymphoma （PNBCL）. Methods A retrospective analysis was performed based on the clinical records of 18 PNBCL cases who were treated from January 2009 to June 2015. The clinical manifestations, imaging features, diagnosis approaches and treatment of them were analyzed. Results The main symptoms were nasal obstruction and rhinorrhea. Of all patients, 15 cases were in Ann Arbor stageⅠE-ⅡE, and 3 cases were in Ann Arbor stageⅢE-Ⅳ. The median age was 51 years （12-76 years）. The ratio of men to women was 11：7. Only 1 patient had B symptoms. Elevated LDH levels were observed in 4 patients. 13 patients were diffuse large B-cell lymphoma（DLBCL）, 3 patients were mantle cell lymphoma, and 2 patients were Burkitt lymphoma. CT examination showed the abnormal nasal soft tissue shadow, with unilateral location and light to moderate enhancement. 14 patients received combination chemotherapy only, and 3 patients received chemotherapy and radiotherapy. Total effective rate was 82.3 % （14/17）. At the time of last follow-up, 5 patients died, and the 3-year OS rate was 54.5%（6/11）. Conclusions Most PNBCL patients are in Ann Arbor stageⅠE-ⅡE and B symptoms are rare, and the most common pathological types is DLBCL. The treatment for PNBCL is chemotherapy, radiotherapy can assist, but the prognosis is poor, and innovative chemotherapy regimens are necessary.