110例原发胃肠道非霍奇金淋巴瘤临床特征与预后分析

目的 探讨原发胃肠道非霍奇金淋巴瘤(PGI-NHL)的病理分型、预后因素和有效的治疗方式.方法 回顾性分析我院110例PGI-NHL患者的临床资料,分析预后相关因子及各种治疗方式的疗效.结果 110例患者男女比例1.56∶1,中位发病年龄58.5岁.发病部位以胃为主,其次为小肠.弥漫大B细胞淋巴瘤(DLBCL)和黏膜相关淋巴组织淋巴瘤(MALT)是主要类型.可追踪病例75例.5年累积生存率62％,中位生存期36个月.单因素预后分析显示胃与肠道的NHL预后相似(P＞0.05),MALT型预后好于DLBCL型(P=0.003).PGI-DLBCL中生发中心(GC)与non-GC的比例为1∶2.82.3种主要的治疗方式中手术联合化疗与单纯手术、单纯化疗相比病死率最低.疾病进展死亡占总病死率的51.7％.结论 本组PGI-DLBCL患者中non-GC比例升高,5年总体生存率较DLBCL总体生存率低;治疗应首选联合化疗,手术仅用于局部并发症的治疗及对巨块型病变的控制;系统性治疗后的患者仍需巩固维持治疗.

Analysis of clinical characteristics and prognostic factors of 110 cases with primary gastrointestinal tract non-Hodgkin's lymphoma

Objective To explore the pathologic types,prognostic factors and effective treatment of PGI-NHL.Methods Clinical data of 110 PGI-NHL patients were analyzed retrospectively,and so did prognostic factors and each treatment outcome.Results Of the 110 patients,the male-female ratio was 1.56∶1with a median age of 58.5 years.Stomach was the most common site and small intestine was the second.The main histological subtypes were diffuse large B-cell lymphoma(DLBCL)and mucosa-associated lymphoid tissue(MALT)NHL.Among the 75 patients followed up,the 5-year overall survival(OS)rate was 62％,the median survival time was 36 months.Univariate analysis showed a similar prognosis between PG-NHL and primary bowel NHL(P ＞ 0.05),and PGI-MALT had better prognosis than PGI-DLBCL.Among PGIDLBCL,the ratio of germinal center(GC)sub-type to non-GC was 1 ∶ 2.82.Among three main treatments,chemotherapy combined with surgery had the lowest mortality rate,compared with each alone.Disease progress mortality was 51.7％ of overall mortality.Conclusion The pewent of non-GC in PGI-DLBCL is higher than that of in nonPGI-NHL.The 5-year OS rate is lower than the 5-year OS rate of DLBCL.Combined chemotherapy is the first line treatment.Surgery is important in the control of the complications of GI tract.Maintenance treatment is important even in those who had systemic treatments.