乳腺弥漫大B细胞淋巴瘤临床特点及预后分析

目的:探讨乳腺弥漫大B细胞淋巴瘤（DLBCL）患者的临床特征及预后。方法:回顾性分析2014年5月起至2018年12月我院收治的18例乳腺DLBCL患者的临床特点及预后。结果:在18例患者中，17例为女性，中位年龄为57岁，病变主要累及右侧乳腺（11/18，61.1%）。将其分为原发性乳腺DLBCL（PB-DLBCL）和继发性乳腺DLBCL（SB-DLBCL）两大类。11例（57.6%）PB-DLBCL与7例（42.4%）SB-DLBCL相比，其具有Ann Arbor分期多为Ⅰ-Ⅱ期（P＜0.01）、B症状少（P=0.013）、相对更高的白细胞计数（P=0.041）、骨髓未累及（P=0.043）、完全缓解（CR）率高（P=0.049）等特点。生存分析发现PB-DLBCL患者5年总生存期（OS）显著长于SB-DLBCL患者（P=0.013）。本研究以非生发中心B细胞型（non-GCB）居多，生发中心型（GCB）与non-GCB型之间OS无显著差异（P=0.885）。所有获得CR患者的生存期均显著延长（P=0.008）。结论:乳腺DLBCL多见于中年女性，以右侧乳腺肿块为主要临床表现，分子分型多为non-GCB型。与SB-DLBCL患者相比，PB-DLBCL患者具有Ann Arbor分期早、B症状少、相对更高的白细胞计数、骨髓未累及、CR率高等特点，并且生存期显著延长。无论是PB-DLBCL和SB-DLBCL，还是GCB型和non-GCB型，获得CR提示预后良好。

Analysis of clinical characteristics and prognosis in breast diffuse large B-cell lymphoma

Objective:To investigate clinical characteristics and prognosis of patients with breast diffuse large B-cell lymphoma (DLBCL).Methods:We conducted a retrospective review in our hospital for DLBCL diagnosed in breast tissue during a period of 5 years.Clinical characteristics and patient outcomes were analyzed.Results:We identified 18 cases,17 of them were female,with a median age of 57 years.Our study showed the lesion mainly involved the right breast (11/18,61.1%).Breast DLBCL was divided into primary breast DLBCL (PB-DLBCL) and secondary breast DLBCL (SB-DLBCL).11 PB-DLBCL cases had higher white blood count (P=0.041),less B symptoms （P=0.013） and bone marrow involvement（P=0.043）,more were Ann Arbor stage I-Ⅱ（P＜0.01）,and higher CR rate（P=0.049） than 7 SB-DLBCL cases.Significant statistical difference in 5-year OS was shown between PB-DLBCL cases and SB-DLBCL cases（P=0.013).Our study classifying breast DLBCL into germinal centre B-cell (GCB) subtypeand non-GCB subtype,confirmed that the non-GCB subtype was most frequent in breast DLBCL.There was no significant difference in 5-year OS between GCB subtype and non-GCB subtype（P=0.885）.However,patients with CR had statistically better 5-year OS than those without CR(P=0.008).Conclusion:Breast DLBCL is a rare hematologic neoplasm that includes PB-DLBCL and SB-DLBCL.The majority patients are middle-aged females,with the right breast mass as the main clinical manifestation.Our study confirmed that the non-GCB subtype is most frequent in breast DLBCL.Compared with SB-DLBCL patients,PB-DLBCL cases had higher white blood count,less B symptoms and bone marrow involvement,more were Ann Arbor stage I-Ⅱ,higher CR rate,and significantly prolonged survival.Whether PB-DLBCL or SB-DLBCL,GCB or non-GCB subtypes,CR indicates a good prognosis.