52例原发性睾丸淋巴瘤的临床分析

Clinical Analysis of 52 Patients with Primary Testicular Lymphoma

目的探究原发性睾丸淋巴瘤(primary testicular lymphoma,PTL)的临床特点,评估不同的治疗模式对预后的影响,提高对该病认识及诊疗水平,从而指导临床、评估预后,以期能进一步提高PTL患者的生活质量,延长生存期。方法回顾性分析云南省肿瘤医院1994年05月至2016年03月收治的52例原发性睾丸淋巴瘤患者的临床资料。结果 (1) 52例PTL患者中位发病年龄60.40岁;I期、IV期共41例;中位OS为25.47月;50例以睾丸肿大或触及包块为疾病首发症状,少数晚期患者合并B症状;22例合并睾丸或邻近组织、器官的其他疾病;17例在明确诊断或疾病进展过程中,出现对侧睾丸或邻近组织的浸润;病理类型以B细胞淋巴瘤多见,其中弥漫大B细胞淋巴瘤占42例;(2)针对分期、一般情况相当的患者,治疗手段单一、采用不含蒽环类化疗方案、总化疗周期数<6是OS预后不良因素(P<0.05),总化疗周期数<6仅是IE/IIE期患者OS预后不良因素(P<0.05);利妥昔单抗的使用与OS无明显相关性(P>0.05)。结论该病侵袭能力极强,整体预后极差。针对分期、一般情况相当的患者,采用综合治疗手段、使用含蒽环类化疗方案、化疗周期数≥6可一定程度上改善预后。

Objective To improve the level of awareness,diagnosis and treatment of primary testicular lymphoma(PTL) by analysing the clinical features and evaluating the effects of different treatment modes on the prognosis. By applying the research results to the clinic and assessingthe prognosis, we can improve the quality of life of PTL patients and prolong their survival. Methods Clinical data of 52 patients with PTL in Tumor Hospital of Yunnan Province from May 1994 to March 2016 were retrospectively analyzed. Results(1) 52 cases of PTL patients’ median age was 60.4 years. There were 41 cases in phase I and IV. The median OS was 25.47 months. The first symptom of the disease was manifested as testicular enlargement or palpable mass in 50 cases. Only a few patients who were in late stage of disease had B symptoms. 22 cases with other diseases associated with testis or adjacent tissues and organs. 17 cases of infiltration with contralateral testis or CNS were found during the diagnosis and treatment. The main pathological type was B cells, of which diffuse large B-cell lymphoma accounted for 42 cases.(2) For patients with the same stage and the common general conditions, single treatment and non-steroidal chemotherapy were prognostic factors of OS(P<0.05). The total number of chemotherapy cycles < 6 was a factor of poor prognosis in patients with IE/IIE stage(P<0.05). The use ofrituximab was not significantly related to OS(P >0.05). Conclus ions The invasive ability of this disease is extremely strong, and the overall prognosis is very poor. For patients with the same stage and the common general conditions, the use of comprehensive treatment methods, the anthracycline-containing chemotherapy regimens and chemotherapy cycles ≥ 6 can improve the prognosis to some extent.