乳腺弥漫大B细胞淋巴瘤临床特点及预后分析

Analysis of clinical characteristics and prognosis in breast diffuse large B-cell lymphoma

目的:探讨乳腺弥漫大B细胞淋巴瘤(DLBCL)患者的临床特征及预后。方法:回顾性分析2014年5月起至2018年12月我院收治的18例乳腺DLBCL患者的临床特点及预后。结果:在18例患者中,17例为女性,中位年龄为57岁,病变主要累及右侧乳腺(11/18,61.1%)。将其分为原发性乳腺DLBCL(PB-DLBCL)和继发性乳腺DLBCL(SB-DLBCL)两大类。11例(57.6%)PB-DLBCL与7例(42.4%)SB-DLBCL相比,其具有Ann Arbor分期多为Ⅰ-Ⅱ期(P<0.01)、B症状少(P=0.013)、相对更高的白细胞计数(P=0.041)、骨髓未累及(P=0.043)、完全缓解(CR)率高(P=0.049)等特点。生存分析发现PB-DLBCL患者5年总生存期(OS)显著长于SB-DLBCL患者(P=0.013)。本研究以非生发中心B细胞型(non-GCB)居多,生发中心型(GCB)与non-GCB型之间OS无显著差异(P=0.885)。所有获得CR患者的生存期均显著延长(P=0.008)。结论:乳腺DLBCL多见于中年女性,以右侧乳腺肿块为主要临床表现,分子分型多为non-GCB型。与SB-DLBCL患者相比,PB-DLBCL患者具有Ann Arbor分期早、B症状少、相对更高的白细胞计数、骨髓未累及、CR率高等特点,并且生存期显著延长。无论是PB-DLBCL和SB-DLBCL,还是GCB型和non-GCB型,获得CR提示预后良好。

Objective:To investigate clinical characteristics and prognosis of patients with breast diffuse large B-cell lymphoma(DLBCL).Methods:We conducted a retrospective review in our hospital for DLBCL diagnosed in breast tissue during a period of 5 years.Clinical characteristics and patient outcomes were analyzed.Results:We identified 18 cases,17 of them were female,with a median age of 57 years.Our study showed the lesion mainly involved the right breast(11/18,61.1%).Breast DLBCL was divided into primary breast DLBCL(PB-DLBCL)and secondary breast DLBCL(SB-DLBCL).11 PB-DLBCL cases had higher white blood count(P=0.041),less B symptoms(P=0.013)and bone marrow involvement(P=0.043),more were Ann Arbor stage I-Ⅱ(P<0.01),and higher CR rate(P=0.049)than 7 SB-DLBCL cases.Significant statistical difference in 5-year OS was shown between PB-DLBCL cases and SB-DLBCL cases(P=0.013).Our study classifying breast DLBCL into germinal centre B-cell(GCB)subtypeand non-GCB subtype,confirmed that the non-GCB subtype was most frequent in breast DLBCL.There was no significant difference in 5-year OS between GCB subtype and non-GCB subtype(P=0.885).However,patients with CR had statistically better 5-year OS than those without CR(P=0.008).Conclusion:Breast DLBCL is a rare hematologic neoplasm that includes PB-DLBCL and SB-DLBCL.The majority patients are middle-aged females,with the right breast mass as the main clinical manifestation.Our study confirmed that the non-GCB subtype is most frequent in breast DLBCL.Compared with SB-DLBCL patients,PB-DLBCL cases had higher white blood count,less B symptoms and bone marrow involvement,more were Ann Arbor stage I-Ⅱ,higher CR rate,and significantly prolonged survival.Whether PB-DLBCL or SB-DLBCL,GCB or non-GCB subtypes,CR indicates a good prognosis.