小儿非霍奇金淋巴瘤的诊断及预后分析

Diagnosis and prognosis of children with non-Hodgkin lymphoma

目的探讨小儿非霍奇金淋巴瘤(non-Hodgkin lymphoma,NHL)的临床表现及预后危险因素。方法收集2006年3月至2012年10月期间初治的81例NHL患儿的资料。采用Kaplan-Meier进行生存分析,统计5年总生存率及无复发生存率。采用卡方检验分析不同临床因素与生存率的关系。采用多因素Logistic回归分析NHL的预后危险因素。结果 81例患儿包括23例前驱淋巴母细胞型,11例成熟T/NK淋巴细胞型,47例成熟B淋巴细胞型;其中以Burkitt淋巴瘤所占比例最高(35.80%)。前驱淋巴母细胞肿瘤患儿主要以外周淋巴结肿大(43.78%)为首发表现;成熟T/NK淋巴细胞肿瘤患儿主要以纵隔受累(45.45%)为首发表现;成熟B细胞肿瘤患儿中,29例Burkitt淋巴瘤患儿主要以腹腔受累(41.40%)为首发表现,15例弥漫性大细胞淋巴瘤患儿以腹部肿块(60.00%)为首发表现。77例患儿(4例放弃治疗)经治疗后,90.91%完全缓解,5.19%部分缓解,2.60%治疗后复发,1.30%出现中枢神经系统浸润。76例患者完成随访,5年的总生存率为67.11%,5年无复发生存率为63.16%。B症状、乳酸脱氢酶水平、临床分期是影响患儿5年总生存率及无复发生存率的因素(P均<0.05)。乳酸脱氢酶(LDH)≥500 U/L(OR:3.294)、临床晚期(Ⅳ期)(OR:2.756)是影响患儿预后的独立危险因素(P<0.05)。结论儿童NHL的临床表现呈多样化,LDH水平及临床分期是影响预后的独立危险因素,可以为早期治疗提供一定的参考。

Objective To explore the clinical features and risk factors influencing the prognosis of childhood non-hodgkin＇s lymphoma（ NHL）. Methods Pathologically diagnosed 81 pediatric patients with NHL and treated in our hospital from March 2006 to October 2012 were collected and analyzed. The 5-years overall survival rate and replace-free survival rate were calculated and analyzed by Kaplan-Meier method. The relationship between survival rates and different factors were analyzed using chi-square test. Logistic analysis were used to analyze risk factors of prognosis.Results Totally 81 pediatric patients with NHL included 23 cases of lymphoblastic lymphoma,11 cases of mature T/NK-cell tumor,and 47 cases of mature B-cell tumor,Burkitt lymphoma was the most common（ 35. 80%）. Swelling of periphery lymph node（ 43. 78%）,mediastinal involvement（ 45. 45%） were observed as initial symptom in lymphoblastic lymphoma and mature T/NK-cell tumor,respectively. Among mature B-cell tumor,the main clinical feature of abdominal cavity（ 41. 40%） was observed in 29 cases of Burkitt lymphoma,and abdominal mass（ 60. 00%） was observed as initial symptom in diffuse large cell lymphoma. 77 pediatric patients with NHL（ 4 cases withdrawing treatment） received treatments were found that 90. 5% attained complete remission（ CR）,5. 19% attained partial remission（ PR）,2. 60% rapidly relapsed after treatment,and 1. 30% appeared the central nervous system infiltration. 76 pediatric patients with NHL were finished the follow up. The 5-years overall survival rate was 67. 11%. The 5-years replace-free survival rate was 63. 16%. B symptoms,the level of lactate dehydrogenase（ LDH）,and clinical stages were the influence factors of 5-years overall survival rate and replace-free survival rate（ P 0. 05）. LDH≥500 U/L（ OR： 3. 294） and late stage（Ⅳ） were the independent risk factors of prognosis（ P 0. 05）. Conclusion Clinical features of pediatric patients with NHL were variable. The level of LDH and late stage（Ⅳ） are independent risk factors of prognosis,which can provide some reference in early treatment.