90例原发性小肠淋巴瘤临床病理特征、穿孔危险因素和预后分析

Clinicopathological Characteristics,Risk Factors of Perforation and Prognosis of Primary Small Intestinal Lymphoma:Analysis of 90 Cases

背景:原发性小肠淋巴瘤起病隐匿,穿孔发生率高,预后不良。目的:探讨原发性小肠淋巴瘤的临床病理特征及其穿孔和预后相关因素。方法:回顾性收集郑州大学第一附属医院2014年1月—2022年1月收治的原发性小肠淋巴瘤病例,总结不同病理类型患者的临床特征,采用Logistic回归分析和Cox回归分析筛选穿孔和预后影响因素。结果:共90例原发性小肠淋巴瘤患者纳入研究,男女比例为2∶1,中位年龄52.5岁,临床症状以腹痛为主(74.4%)。病理类型均为非霍奇金淋巴瘤,其中B细胞淋巴瘤70例,以弥漫大B细胞淋巴瘤为主,T细胞淋巴瘤20例。T细胞淋巴瘤消化道并发症发生率高于B细胞淋巴瘤(78.6%对48.6%,P=0.001),前者常见并发症为肠穿孔,后者则为肠梗阻。多因素Logistic回归分析显示肿瘤侵犯消化道多部位、乳酸脱氢酶(LDH)升高、T细胞淋巴瘤是发生穿孔的独立危险因素。单因素Cox回归分析显示白蛋白降低、LDH升高、T细胞淋巴瘤、穿孔和单纯手术治疗与预后不良相关,其中仅单纯手术治疗在多因素Cox回归分析中被鉴定为死亡独立危险因素(HR=8.332,95%CI:1.453~47.772,P=0.017)。结论:T细胞型、LDH升高和侵犯消化道多部位的原发性小肠淋巴瘤穿孔风险高。单纯手术治疗与预后不良显著相关,对于出现肠穿孔等并发症的原发性小肠淋巴瘤患者,在行肠道手术后给予规律化疗十分必要。

Background:Primary small intestinal lymphoma is an insidious onset gastrointestinal tumor with a high probability of perforation and poor prognosis.Aims:To investigate the clinicopathological characteristics and the factors related to perforation and prognosis in primary small intestinal lymphoma patients.Methods:The clinical data of patients with primary small intestinal lymphoma admitted to the First Affiliated Hospital of Zhengzhou University from January 2014 to January 2022 were collected retrospectively.The clinical features of patients with different pathological types were compared,and factors related to perforation and prognosis were identified by Logistic regression analysis and Cox regression analysis,respectively.Results:Ninety patients with primary small intestinal lymphoma were enrolled,the male to female ratio was 2∶1,and the median age was 52.5 years old.Abdominal pain was the most common symptom complained by patients(74.4%).All patients were diagnosed as non⁃Hodgkin’s lymphoma pathologically,of which 70 were B⁃cell lymphoma and 20 were T⁃cell lymphoma;diffuse large B⁃cell lymphoma was the most common histological type.Patients with T⁃cell lymphoma had a higher incidence of gastrointestinal complications than those with B⁃cell lymphoma(78.6%vs.48.6%,P=0.001).Perforation was more commonly seen in T⁃cell lymphoma,and intestinal obstruction was more commonly seen in B⁃cell lymphoma.Multivariate Logistic analysis demonstrated that multisite involvement,elevation of lactate dehydrogenase(LDH),and T⁃cell lymphoma were the independent risk factors for perforation,while in univariate Cox regression analysis,decreased albumin,increased LDH,T⁃cell lymphoma,perforation and surgical treatment without chemotherapy were associated with poor prognosis.Furthermore,multivariate Cox regression analysis suggested that only surgical treatment without chemotherapy was an independent risk factor for death(HR=8.332,95%CI:1.453⁃47.772,P=0.017).Conclusions:T⁃cell originated primary small intestinal lymphoma and those with increased LDH or involving multisite of gastrointestinal tract has a higher incidence of perforation.Surgical treatment without chemotherapy is strongly correlated with adverse outcomes.A regular chemotherapy after surgical treatment is highly recommended for primary small intestinal lymphoma patients complicated with perforation.