17例原发胃肠道弥漫大B细胞淋巴瘤临床病例分析

目的:探讨原发胃肠道弥漫大B细胞淋巴瘤（PGI-DLBCL）的临床特点、治疗方案及疗效。方法:收集我院2006年12月至2013年4月诊治的17例PGI-DLBCL患者的临床资料，对其临床特征、治疗方法、疗效进行回顾性分析，临床分期采用Ann Arbor分期法，采用国际预后指数（IPI）和Ki-67评估，观察短期缓解率，分析临床因素对疗效的影响。结果:17例PGI-DLBCL患者中，男女比例为1.13∶1（男9例，女8例），中位年龄47岁（15~69岁）；有B症状者6人，占35.3%；随访时间为4~70个月，中位随访时间为12个月；Ann Arbor分期Ⅰ/Ⅱ期10例（58.8%），Ⅲ/Ⅳ期7例（41.2%）；IPI评分≤2分患者11例（64.7%），IPI评分＞2分患者6例（35.3%）；6例可评估免疫分型的患者中生发中心型4例（66.7%），非生发中心型2例（33.3%）；按部位，胃12例，结肠3例，直肠2例；所有患者均接受2疗程以上的化疗，采用CHOP、CHOP（E）方案化疗患者9例（52.9%），采用利妥西单抗联合化疗者8例（47.1%）。近期疗效显示:16例可评估患者，5例CR（31.3%），5例PR（31.3%），3例SD（18.8%），3例PD（18.8%）；IPI评分≤2分患者50%达CR，IPI评分>2分患者均未达CR；7例Ann Arbor分期Ⅲ-Ⅳ期患者，1例达CR（14.3%），9例Ann Arbor分期Ⅰ-Ⅱ期患者，4例达CR（44.4%）；7例患者联合了利妥西单抗治疗，总有效率达71.4%（2例CR、3例PR），9例未联合利妥西单抗治疗，总有效率为55.6%（3例CR、2例PR）。结论:17例PGI-DLBCL患者多为中年，确诊依靠手术或内镜病理活检，大部分患者Ki-67表达＞40%，需加强超声胃镜及PET-CT检查，以便更好的评估预后。预后相关因素分析显示IPI评分与其预后相关。治疗中利妥西单抗联合化疗的治疗反应较好，需扩大样本进一步研究。

Clinical analysis of 17 cases of primary gastrointestinal diffuse large B-cell lymphoma

Objective:To investigate the clinical features，treatment regimen and therapeutic effect of primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL) in Xijing hospital.Methods:The clinical features，treatment methods and curative effect of 17 patients who were newly diagnosed as PGI-DLBCL in Xijing hospital from December 2006 to April 2013 were analyzed retrospectively.The clinical stage was analyzed by Ann Arbor staging method.International prognostic index (IPI) and Ki-67 were applied to observe the short-term remission rate and analyze impact of clinical factors on the efficacy.Results:Among the 17 patients with PGI-DLBCL，the ratio of male to female was 1.13∶1 (9 males and 8 females)，median age was 47 years (15~69 years)，and there were 6 patients with B symptom(35.3%).The follow-up period was 4~70 months，the median of which was 12 months.Among all patients，10 cases were Ann Arbor stageⅠ/Ⅱ(58.8%)，7 cases were stage Ⅲ/Ⅳ(41.2%).11 cases(64.7%) had IPI score less than or equal to 2 points，6 cases(35.3%) had score more than 2 points；4 cases (66.7%) of germinal center type and 2 cases (33.3%) of non-germinal center type existed among 6 patients who could be evaluated for immunephenotyping.According to primary site，there were 12 cases from stomach，3 cases from colon and 2 cases from rectum.All patients received more than 2 courses of chemotherapy，in which 9 patients (52.9%) underwent CHOP，CHOPE，CMOPE，ESHAP，EPOCH chemotherapy regimen，and 8 patients (47.1%) chemotherapy combined with rituximab.Recent curative effect showed that among 16 patients who could be evaluated，5 patients were CR (31.3%)，5 patients PR (31.3%)，3 patients SD (18.8%)，and 3 patients PD (18.8%).50% cases were CR with IPI score less than or equal to 2 points and nobody were CR with IPI score more than 2 points.1 patient was CR (14.3%) in 7 patients with Ann Arbor stage Ⅲ-Ⅳ，and 4 patients were CR (44.4%) in 9 patients with Ann Arbor stage Ⅰ-Ⅱ.The total effective rate of 7 cases who received chemotherapy combined with rituximab was 71.4% (2 cases of CR，3 cases of PR)，and that of 9 cases who never underwent rituximab treatment was 55.6% (3 cases of CR，2 cases of PR).Conclusion:After analysis of 17 cases of PGI-DLBCL patients，we learned that PGI-DLBCL appeared mostly in middle age，diagnosis of which usually depended on surgery or endoscopic pathology biopsy.The majority of patients accompanied Ki-67 expression more than 40%，in order to evaluate the prognosis better，endoscopic ultrasonography and PET-CT need to be strengthened.IPI score is related to the prognosis.The chemotherapy with rituximab resulted in better consequence，and further studies are needed to expand the sample.