原发性睾丸弥漫大B细胞淋巴瘤的临床特征与预后分析

Clinical characteristics and prognosis of primary testicular diffuse large B-cell lymphoma

目的探讨原发性睾丸弥漫大B细胞淋巴瘤(PT-DLBCL)的临床特征、实验室指标、免疫组织化学及治疗方案对其预后的影响。方法回顾性分析南通大学附属医院及大连医科大学附属第二医院2000年1月1日至2022年12月31日期间诊治的PT-DLBCL患者的临床资料、治疗方案及预后情况;单因素及多因素分析各临床指标(一般临床指标、病理及免疫组织化学指标、ECOG评分、治疗方案、初治反应和复发)对患者预后的影响。结果共纳入47例,中位发病年龄64岁,中位总生存时间41.6个月,1年、3年及5年的总生存率分别为93%,77%,59%。Kaplan-Meier单因素分析显示,年龄≥70岁、ECOG评分≥3分、IPI评分≥4分、未联合应用蒽环类药物、未联合应用利妥昔单抗、单一治疗方式、初治反应无效及复发与PT-DLBCL患者预后不良相关(均P<0.05);多因素Cox回归分析显示ECOG评分≥3分、未联合应用利妥昔单抗及初治反应无效是PT-DLBCL预后不良的独立危险因素(均P<0.05)。结论PT-DLBCL罕见且预后差,尽早诊断且联合应用蒽环类药物及利妥昔单抗可能改善预后。

Objective To investigate the clinical characteristics and prognosis of primary testicular diffuse large B-cell lymphoma(PT-DLBCL).Methods The clinical data,treatment regimen and prognosis of PT-DLBCL patients were analyzed retrospectively,from the records of the Affiliated Hospital of Nantong University and the Second Affiliated Hospital of Dalian Medical University from Jan.1,2000 to Dec.31,2022.Results The median age of the 47 PT-DLBCL patients was 64 years old.The median overall survival(OS)was 41.6 months,with 1-year,3-year,and 5-year PT-DLBCL OS of 93%,77%,and 59%,respectively.Kaplan-Meier univariate analysis demonstrated that a diagnosed age≥70 years,Eastern cooperative oncology group(ECOG)score≥3,international prognostic index(IPI)score≥4,no combination of anthracycline and rituximab,a single treatment regimen,ineffective initial treatment and relapse,were associated with an adverse prognosis in PT-DLBCL(all P<0.05).Multivariate Cox regression analysis showed that an ECOG score≥3,no application of Rituximab,and an ineffective initial treatment response were independent risk factors for the poor prognosis of PT-DLBCL(all P<0.05).Conclusion PT-DLBCL is rare and associated with a poor prognosis.Early diagnosis and therapy with a combination of anthracyclines and rituximab may improve outcomes.