原发性胃肠道非霍奇金淋巴瘤的临床研究

Clinical and Pathological Features of Primary Gastrointestinal Non-Hodgkin's Lymphoma

目的 :回顾性分析原发性胃肠道非霍奇金淋巴瘤 (PGINHL)的形态学和病理类型、临床特征、治疗及预后。方法 :收集病理确诊的原发性胃肠道非霍奇金淋巴瘤 89例 ,行常规病理和免疫组化染色 (CD3、CD5、CD7、CD1 0、CD2 0、CD2 3、CD4 5RO、Kappa、Lambda、CyclinD1、Ki 6 7) ,按照WHO分类方法重新分类 ,借以探讨其临床特征。 结果 :①ⅠE期 2 4例 ,ⅡE期 33例 ,ⅢE期 1 9例 ,ⅣE期 1 3例。②T细胞性和B细胞性PGINHL各 1 7例和 72例。③MALT淋巴瘤共 1 5例 ,其中胃MALT瘤 1 4例 ,小肠 1例。④ 3、5年总生存率直接法计算分别为 77 0 % (5 7/ 74 )和 5 3 6 % (30 / 5 6 )。其中ⅠE期 2 4例 ,3、5年总生存率分别为 1 0 0 % (1 9/ 1 9)和 85 7% (1 2 / 1 4 ) ,ⅡE期 33例 ,3、5年总生存率分别为 85 2 % (2 3/ 2 7)和 6 5 % (1 3/ 2 0 ) ,ⅢE期 1 9例 ,3、5年总生存率分别为 5 8 8% (1 0 / 1 7)和 30 8% (4 / 1 3) ,ⅣE期 1 3例 ,3、5年总生存率分别为 4 5 5 % (5 / 1 1 )和1 1 1 % (1 / 9)。结论 :PGINHL临床表现无特异性 ,容易延误诊断 ;胃部发生率最高 ,临床分期以ⅠE、ⅡE期为主 ,病理分型以中度恶性和B细胞性为主 ,ⅠE期和ⅡE期临床预后明显比ⅢE期和ⅣE期好 ,B细胞性临床预后较T细胞性好 ;根治性手术?

Objective:The study was initiated to obtain histologic distribution, clinical features, and treatment results in patients with primary gastrointestinal non Hodgkins lymphomas.Methods:Between January 1990 and January 2000, 89 PGI NHL patients were eligible to evaluate clinical features. Histological and immunohistological studies were routinely used and all the specimens were reclassified according to the recently published WHO classification system.Results:①Clinically, among the 89 patients, there were 24 patients in stage ⅠE, 33 in stage ⅡE, 19 in stage ⅢE and 13 in stage ⅣE. ②Immunohistological studies revealed 72 patients were with B cell type and only 17 with T cell type. ③ Altogether, 15 MALT lymphoma were diagnosed among 89 PGI NHL patients, and 14/15 were found primary in the stomach. ④ The 3 year and 5 year overall survival were 77 0%(57/74) and 53 6%(30/56) for the total group.Conclusion:No clinical symptoms and signs have been found specific for the diagnosis of PGI NHL. Most patients were in stage ⅠE,ⅡE when diagnosed and the intermediate grade and B cell type were more common than the other. Surgical resection of the tumor and standard combined chemotherapy post surgery were suggested to be the most effective measures for the long term survival of the PGI NHL patients.