原发肾淋巴瘤临床特征及治疗方法和预后特点分析

Clinical analysis regarding symptom,therapy and prognosis of patients with primary renal lymphoma

目的探讨原发性肾淋巴瘤(PRL)的临床特征及预后,以加强对该病的认识。方法收集2001年1月至2016年12月北京市普仁医院收治的经病理及免疫组化确诊的9例PRL患者的病例资料,回顾性分析PRL的临床特点、治疗方法及预后情况。结果 9例患者的中位发病年龄为57(45～77)岁,首发症状主要表现为腰痛,主要病理类型为弥漫大B细胞型淋巴瘤(8/9,88. 8%),1例为小淋巴细胞型淋巴瘤(1/9,11. 1%)。所有患者均采用手术明确病理,其中行患肾根治性切除术者4例(44. 4%),非根治性切除术(穿刺活检、肾部分切除)者5例(55. 6%),各有1例复发。术后均进行化疗,完全缓解4例(44. 4%),部分缓解5例(55. 6%);年龄、性别、分期、LDH水平、β2-MG水平、病理分型及是否应用利妥昔单抗在疾病完全缓解率方面差异均无统计学相关性(P> 0. 05),中位随访时间18(5～58)个月,存活8例,其中4例仍完全缓解,中位无进展时间为17(4～58)个月。结论 PRL治疗采用化疗为主的综合治疗,早期的肾部分切除手术加术后化疗,可提高患者生存率,利妥昔单抗能改善预后,但大规模的临床研究仍需进行。

Objective To analyze symptom,therapy and prognosis of patients with primary renal lymphoma(PRL).Methods The clinical data of 9 pathologically confirmed PRL patients in our center from January 2001 to December 2016 was collected and analyzed for treatment and prognosis.Results Age of onset:45 to 77,median 57.Initial symptom:back pain.Pathological type:diffuse large B cell lymphoma(DLBCL)(8/9,88.8%),small lymphocytic lymphoma(SLL)(1/9,11.1%).Radical nephrectomy(4/9,1 relapsed).Needle biopsy+nephron sparing surgery(5/9,1 relapsed).All cases were with postsurgery chemotherapy.Complete remission(4/9,44.4%);partial remission(5/9,55.6%).No significant relationship was found between complete remission and age,sex,stage,LDH,β2-MG,pathological type,application of rituximab(P>0.05).After median 18(5~58)mo follow-up,8/9 patients survived and 4 maintained complete remission.The median progress-free survival was 17(4~58)mo.Conclusion Early nephron sparing surgery and adjuvant chemotherapy might improve survival of patients with PRL.Rituximab might improve prognosis.Larger clinical research is necessary.