肠道T细胞淋巴瘤的预后分析

目的 了解我国肠道T细胞淋巴瘤（ITCL）的预后情况,探讨不同临床病理因素和EB病毒基因产物对其预后的影响,以期寻找确切的预后指标。方法 收集42例ITCL,运用免疫组织化学LSAB法染色观察CD4、CD8、CD45RO、CD56、TA-1和EB病毒潜伏膜蛋白（LMP-1）的表达,采用聚合酶链反应（PCR）检测TCR-γ基因重排扩增,运用EBER1/2原位杂交检测EB病毒感染。收集全部42例ITCL的临床资料并进行随访。应用SPSS10.0软件分析临床病理、免疫表型及EB病毒基因产物各项指标与治疗及生存率曲线的关系。结果 （1）42例ITCL中有随访结果者29例（69%）。存活6例,最长存活时间156个月（13年）。死亡23例,其中复发4例,存活时间0.3-24.3个月,存活时间中位数3.0个月,1年生存率和2年生存率分别为30%和22%。（2）在病灶为单发或多发,患者是否出现发热、便血、肠穿孔、淋巴结转移等临床表现,肿瘤细胞是否表达CD4、CD8、CD56、LMP-1,有无TCR-γ基因重排、手术治疗后是否并化疗或放疗等其他治疗方法各因素中,除TCR-γ基因重排（P=0.0078,）和不同的治疗方法（P=0.0250）外,其他各因素与预后不相关。（3）没有发现有意义的预后因素。结论 肠道T细胞淋巴瘤临床进程凶猛、预后差的特殊表现可能归因于其肿瘤细胞的细胞毒性细胞属性以及肿瘤发生发展过程中病毒病因学的影响。

Analyzing of prognosis of intestinal T-cell lymphoma

OBJECTIVE: To investigate the roles of different clinicopathological features and expression of EBV genome in prognosis of intestinal T-cell lymphoma (ITCL). METHODS: Polymerase chain reaction for TCR-gamma gene rearrangement, in situ hybridization for EBER1/2 and immunohistochemical staining for CD4, CD8, CD45RO, CD56, TIA-1 were investigated and all patients followed-up. The LMP-1 expression was determined in forty-two ITCLs cases. The relationship between clinical data, different clinicopathological features, expression of EBV genome and prognosis were analyzed by SPSS10.0 program. RESULTS: (1) All 42 cases of ITCL had an extremely poor prognosis with a median survival of 3.0 months, of which the one year survival rate and two year survival rate being 30% and 22% respectively. (2) The patients without TCR-gamma gene rearrangements showed poorer prognosis than those with TCR-gamma gene rearrangements, and the patients who received operation and chemotherapy showed better prognosis than those who only received operation (P < 0.05). (3) No significant prognostic factor for ITCLs was determined. CONCLUSION: The special clinicopathological features of ITCL could be due to the cytotoxic function and the role of EBV infection in the pathogenesis of ITCL.