原发性肠道非霍奇金淋巴瘤53例临床预后分析

Prognosis Analysis of 53 Cases with Primary Intestinal Non- Hodgkin's Lymphoma

背景与目的:胃肠道是淋巴瘤最常见的结外侵犯部位。本文对原发性肠道非霍奇金淋巴瘤的临床及病理特征进行分析,探讨各种临床指标与预后的关系。方法:选择1980年1月至2000年1月我院治疗的原发性肠道非霍奇金淋巴瘤共53例,均在我院腹部外科或内科接受手术治疗或化疗并进行随访。应用SPSS10.0软件行生存分析并对各临床指标与预后的关系进行Cox单因素和多因素分析。结果:5年总生存率为49.59%,10年预期总生存率为41.33%。log-rank单因素分析显示病理免疫表型(T/B)、有无B症状、血清乳酸脱氢酶(lactatedehydrogenase,LDH)是否升高、临床分期(包括Musschoff和Rohitiner两种分期法)、PS状态、能否完全切除、肠病灶数等因素都与生存密切相关。而年龄、性别、肿瘤大小和治疗模式与总生存期无关。Cox模型进行多因素分析发现仅病理免疫表型(T或B细胞型)与总生存期有关。结论:原发性肠道非霍奇金淋巴瘤的病理免疫表型是独立的预后危险因素,T细胞性淋巴瘤其临床进程快、疗效及预后差。

BACKGROUND & OBJECTIVE: Gastrointestinal tract is the most co mm on extranodal involvement site of lymphoma. The purpose of this study was to inv estigate the clinical and pathological features of primary intestinal non- Hodg kin's lymphoma (NHL) and to discuss the relationship between clinical data and t he prognostic factors. METHODS: From January 1980 to January 2000, 53 cases with primary intestinal NHL were included. All these patients were treated in Depart ment of Abdominal Surgery or Department of Medical Oncology, Cancer Center, Sun Yat- sen University. The relationship between clinical data and prognosis were analyzed by SPSS 10.0. RESULTS: The 5- year and 10- year survival rates of pri mary intestinal NHL patients were 49.59% and 41.33% , respectively. Log- ran k univariate analysis showed that histological immunophenotype,B symptom,serum l actate dehydrogenase(LDH) level,clinical staging(Musschoff and Rohitiner),perfor mance status,complete resection,single or multiple lesions were closely associat ed with survival (P< 0.05); while age,gender,tumor size,and therapy modality wer e not associated with overall survival. Cox model multivariate analysis indicate d that only histological immunophenotype was closely associated with overall sur vival. CONCLUSION: The histological immunophenotype was an independent prognosti c risk factor for primary intestinal NHL. Primary intestinal T cell lymphoma was characterized by short clinical course, poor response and prognosis; more effec tive therapy strategy should be further explored.