原发性胃肠道弥漫大B细胞淋巴瘤51例临床特征及预后分析

目的 探讨原发性胃肠道弥漫大B细胞淋巴瘤（PGI-DLBCL）的临床特征及预后.方法 对2009年1月至2013年8月收治的51例PGI-DLBCL患者的临床病理资料、治疗方法和预后进行回顾性分析.结果 51例PGI-DLBCL患者中,男31例,女20例,中位发病年龄48岁（16～80岁）,患者临床表现主要为腹痛、腹胀、腹部肿块、恶心、呕吐等;原发于胃29例（56.86％）,小肠15例（29.41％）,结肠4例（7.84％）,直肠1例（1.90％）,混合部位2例（3.92％）.包块直径≥10 cm患者13例（25.49％）.24例（47.06％）肿瘤细胞来源于生发中心（GCB）,27例（52.94％）来源于非生发中心（non-GCB）.单因素分析显示肿瘤细胞来源、原发部位（胃或肠道）和大包块对患者预后无明显影响;Lugano分期Ⅲ～Ⅳ期、乳酸脱氢酶（LDH）增高、国际预后指数（IPI）评分3～5分和CA125增高组患者的3年生存率低于Lugano分期Ⅰ～ⅡE期、LDH正常、IPI评分0～2分和CA125正常组患者,差异均有统计学意义（均P＜ 0.05）.利妥昔单抗联合CHOP样方案化疗组患者同单纯CHOP样方案化疗组患者生存率差异无统计学意义（P＞0.05）,手术联合化疗组患者生存率高于单纯化疗组.结论 Lugano分期、IPI评分、LDH增高、CA125增高对于预测PGI-DLBCL患者的生存和指导治疗有重要意义.

Clinical features and prognostic analysis of 51 patients with primary gastrointestinal diffuse large B-cell lymphoma

Objective To analyze the clinical characteristics and prognostic factors in patients with primary gastrointestinal diffuse large B-cell lymphoma （PGI-DLBCL）,and to improve the diagnosis and treatment of PGI-DLBCL.Methods Retrospective analysis was conducted in 51 cases of PGI-DLBCL between January 2009 and August 2013.The data included clinical manifestations,pathological features,treatment regimens and prognosis.Results 51 patients included 31 males and 20 females,the range of ages was from 16 to 80 years old,median age was 48 years old.The major clinical presentation were abdominal pain,abdominal distension,abdominal mass,nausea and vomiting,abdominal mass.The occurrences in stomach,small intestine,colon,rectum and multiple involvement were 56.86 %,29.41%,7.84 %,1.90 % and 3.92 % respectively.The mass bigger than 10 cm was found in 13 cases （25.49 %）.47.06 % （24/51） of the cases belonged to the GCB subtype and 52.94 % （27/51） belonged to the non-GCB subtype.There was no significant impact of lymphoma cell origin,disease distribution （stomach or intestinal） and mass on prognosis of lymphoma treatment.The univariate analysis revealed that the patients with Lugano stage Ⅳ,increased level of serum lactate dehydrogenase （LDH）,modified-international prognosis index （modified IPI） 3-5 and increased level of CA125 had poor prognosis （all P 〈 0.05）.There was no difference of survival rate between patients treated with rituximab plus chemotherapy and single CHOP like therapy.Surgery plus postoperative chemotherapy significantly improved survival of patients treated with simple chemotherapy （P 〉 0.05）.Conclusion The clinical Lugano stage,IPI score,increased LDH and CA125 are important prognostic factors of PGI-DLBCL.