摘要
目的分析探讨原发胃肠道弥漫性大B细胞淋巴瘤(PGI-DLBcL)临床治疗方法的合理选择。方法收集1998-2010年上海仁济医院收治的PGI-DLBCL 124例。剔除因并发症急诊手术治疗及随访资料不全病例,以年龄和Ann Arbor分期为配对因素,按l:1:1比例选择单纯手术、单纯化疗和手术联合化疗病例各23例进行病例对照研究。通过免疫组化检测CDl0、BCL一6和MUMl表达,并进行免疫表型分型。回顾性分析69例PGI-DLBCL病人的临床资料、免疫表型分型、治疗方法及预后,并进行统计学分析。结果 69例病人免疫表型分型:30.4%(21/69)为生发中心B细胞(GCB)型,69.6%(48,69)为非GCB型。69例病人2年、3年和5年总体存活率(0S)分别为69.5%、58.7%和42.4%。Ann Arbor临床分期I_E、Ⅱ_E期病人平均OS(61.5±5.9)个月长于Ⅲ_E、Ⅳ_E期病人[(32.3±6.2)个月],差异有统计学意义(P<0.05)。GCB型病人平均OS(73.9±8.3)个月长于非GcB型病人[(48.1±5.8)个月]。差异有统计学意义(P<0.05)。单纯手术组、单纯化疗组和手术联合化疗组在年龄、性别、发病部位、Ann Arbor分期、有无B症状和免疫表型分型方面无显著性差异。单纯化疗组和手术联合化疗组中利妥昔单联合cHOP化疗(R-CHOP)与传统CHOP化疗病人比例差异无统计学意义。生存分析显示:手术联合化疗组平均0S(73.9±7.8)个月长于单纯手术组[(37.5±5.8)个月]和单纯化疗组[(34.8±6.4)个月]。差异有统计学意义(P<0.05)。结论 Ann Arbor临床分期和免疫表型分型对PGI-DLBcL预后判断具有重要意义,手术联合术后化疗是PGI-DLBCL合理的治疗方法 。
Objective To assess the clinical characteristics,treatment and prognosis of primary gastrointestinal diffuse large B-cell lymphoma(PG1-DLBCL).Methods 124 patients diagnosed with PGI-DLBCL were admitted to Renji Hospital from 1998 to 2010.23 patients treated with surgery alone,23 patients with chemotherapy alone and 23 patients with surgery plus postoperative chemotherapy were selected through random match method by age and Ann Arbor stages.Immunohistochemistry was carried out using EnVision methods for CD10,Bcl-6 and MUM1.The clinicopathologic features and follow-up data were analyzed by Kaplan-Meier method,log-rank test and \2 test.Results According to the data of immunohistochemistry,30.4%(21/69) of the cases belonged to GCB subtype and 69.6%(48/69) belonged to non-GCB subtype.The overall 2,3 and 5-year survival rates of 69 cases were 69.5%,58.7%and 42.4%.Patients of stage IE and HE had a better overall survival than those of stage HIE and IVE(P<0.05).Patients of GCB subtype had a better overall survival than those of non-GCB subtype(P<0.05).Patients in surgery plus postoperative chemotherapy group had a better survival than those in surgery alone group and chemotherapy alone group(P<0.05).Conclusions The immunophenotype classification and Ann Arbor stages of PGI-DLBCL is found to have prognostic significance.Compared with surgery alone and chemotherapy alone,surgery plus postoperative chemotherapy could significantly improve the overall survival.
出处
《中国实用外科杂志》
CSCD
北大核心
2012年第S1期31-34,共4页
Chinese Journal of Practical Surgery
关键词
淋巴瘤
B细胞
胃肠肿瘤
免疫表型分型
化学治疗
手术切除
lymphoma,large B-cell
gastrointestinal neoplasms
immunophenotyping
chemotherapy
surgical intervention