结直肠非霍奇金淋巴瘤32例诊治分析

目的 总结结直肠非霍奇金淋巴瘤(NHL)的临床特点及诊治经验.方法 通过对1988年1月至2006年12月我院收治的32例患者的临床资料进行回顾性分析,探讨结直肠NHL的临床特点及诊治经验.结果 本研究包括B细胞NHL患者22例,T细胞NHL患者10例.B细胞型男性14例,女性8例,中位年龄60.5岁.T细胞型男性5例,女性5例,中位年龄31.0岁.回盲部为最常见的发病部位,分别占B及T细胞型的77.3%及60.0%,常见的临床表现为腹痛、消瘦及腹部包块.有明确亚分型的14例B细胞NHL患者中,弥漫大B细胞淋巴瘤(DLBCL)占64.3%.B细胞型中病变局限(Ⅰ～Ⅱ1期)者占40.9%.10例T细胞NHL为Ⅳ期,3例伴消化道大出血,4例伴穿孔.B细胞型患者均接受了手术及以CHOP为主的化疗.中位随访时间55个月,无病生存率88.2%.10例T细胞型患者中,8例接受了手术,有条件者均接受了化疗.5例患者于术后2个月内死亡,已知3例患者存活23个月以上.结论 结直肠NHL好发于回盲部,B细胞型更为常见,且绝大多数为DLBCL.手术加化疗为目前主要的治疗手段.B细胞型患者治疗后预后良好;T细胞型预后差,诊治应更为积极.结直肠NHL保留器官治疗的前景仍有待于进一步的研究来明确.

Abstract：

Objective To summarize the clinical features, diagnostic and therapeutic experiences of colorectal Non-Hodgkin's lymphoma (NHL). Methods Clinical data of 32 patients with colorectal NHL admitted to our hospital from January 1988 to December 2006 was retrospectively analyzed. Results This study included 22 B-cell NHL and 10 T-cell NHL cases. In the B-cell NHL group, the male: female ratio was 14:8 and the median age was 60. 5 years. In the T-cell NHL group, the male: female ratio was 5:5 and the median age was 31.0 years. The ileocecal region was most frequently involved in both groups, which accounted for 77. 3% and 60. 0% of the B and T group respectively. The common clinical manifestations included abdominal pain, weight loss, and abdominal mass. Of the 14 cases of B-cell NHL with definite subtype classifications, 64. 3% were of the Diffuse Large B-cell Lymphoma (DLBCL) type. Among the 22 B-cell NHL, 40. 9% were with localized diseases (stage Ⅰ - Ⅱ 1), while all 10 patients in T-cell NHL group were in stage Ⅳ with 3 patients complicated with massive GI bleeding and 4 with perforation. All patients of B-cell type received chemotherapy utilizing mainly CHOP after surgical resection. After a median follow-up of 55 months, the disease-free survival was rate 88. 2%. Among the T-cell NHL group, 8 out of 10 patients underwent surgery and chemotherapy was given to all those who could tolerate it. Five patients died within 2 months after surgery. It's known that 3 patients were still alive after 23 months. Conclusions The ileocecal region is the most frequently involved site of the colorectal NHL. The histology is usually B-cell type with a majority being DLBCL. Currently R-CHOP chemotherapy after the surgical resection is the principal treatment modality. Patients of B-cell type have a better prognosis while the prognosis of T-cell NHL is poor. Therefore more aggressive diagnostic and therapeutic approaches are recommended for T-cell NHL patients. The prospective of organ preservation treatment for colorectal NHL is still in need of further investigations.

The diagnosis and treatment of Colorectal Non-Hodgkin's lymphoma of 32 cases

Objective To summarize the clinical features, diagnostic and therapeutic experiences of colorectal Non-Hodgkin's lymphoma (NHL). Methods Clinical data of 32 patients with colorectal NHL admitted to our hospital from January 1988 to December 2006 was retrospectively analyzed. Results This study included 22 B-cell NHL and 10 T-cell NHL cases. In the B-cell NHL group, the male: female ratio was 14:8 and the median age was 60. 5 years. In the T-cell NHL group, the male: female ratio was 5:5 and the median age was 31.0 years. The ileocecal region was most frequently involved in both groups, which accounted for 77. 3% and 60. 0% of the B and T group respectively. The common clinical manifestations included abdominal pain, weight loss, and abdominal mass. Of the 14 cases of B-cell NHL with definite subtype classifications, 64. 3% were of the Diffuse Large B-cell Lymphoma (DLBCL) type. Among the 22 B-cell NHL, 40. 9% were with localized diseases (stage Ⅰ - Ⅱ 1), while all 10 patients in T-cell NHL group were in stage Ⅳ with 3 patients complicated with massive GI bleeding and 4 with perforation. All patients of B-cell type received chemotherapy utilizing mainly CHOP after surgical resection. After a median follow-up of 55 months, the disease-free survival was rate 88. 2%. Among the T-cell NHL group, 8 out of 10 patients underwent surgery and chemotherapy was given to all those who could tolerate it. Five patients died within 2 months after surgery. It's known that 3 patients were still alive after 23 months. Conclusions The ileocecal region is the most frequently involved site of the colorectal NHL. The histology is usually B-cell type with a majority being DLBCL. Currently R-CHOP chemotherapy after the surgical resection is the principal treatment modality. Patients of B-cell type have a better prognosis while the prognosis of T-cell NHL is poor. Therefore more aggressive diagnostic and therapeutic approaches are recommended for T-cell NHL patients. The prospective of organ preservation treatment for colorectal NHL is still in need of further investigations.