原发胃肠与原发结内弥漫大B细胞淋巴瘤临床特点及治疗预后的对比分析

目的:对原发胃肠弥漫大B细胞淋巴瘤(PGI-DLBCL)与原发结内弥漫大B细胞淋巴瘤(PN-DLBCL)的临床病理特点及治疗预后对比分析。方法:回顾性分析我院肿瘤中心2013年6月至2018年12月间收治确诊为PGI-DLBCL 70例和PN-DLBCL 80例,卡方检验比较原发胃肠与结内的DLBCL临床病理特征、治疗特点,应用Kaplan-Meier法进行生存分析,并行log-rank检验,多因素分析采用COX比例风险模型。结果:PGI-DLBCL较PN-DLBCL分期偏晚,LDH增高多,联合有手术治疗多,放疗相对较少。单因素分析提示,PGI-DLBCL的年龄、LDH、IPI积分这3项是预后的影响因素;结内DLBCL患者组年龄、双表达、LDH、IPI积分、KI67%值、分期这6项是预后的影响因素,COX多因素分析提示PGI-DLBCL的年龄≥60岁、LDH升高是其生存的独立危险因素;IPI≥3分、KI67≥70%是影响结内DLBCL生存的独立危险因素。结论:PGI-DLBCL患者应提高早期诊断率,治疗上可根据年龄、LDH独立的预后危险因素制定综合治疗方案,目标超过结内DLBCL的预后。

Comparative analysis of clinical features and post-treatment of primary gastrointestinal and primary nodal diffuse large B-cell lymphoma

Objective:To evaluate the difference between primary gastrointestinal diffuse large B-cell lymphoma(PGI-DLBCL)and primary nodal diffuse large B-cell lymphoma(PN-DLBCL)in clinical-pathological features,treatment methods and prognostic factors.Methods:A retrospective analysis was performed on 70 PGI-DLBCL and 80 PN-DLBCL patients treated in cancer center of our hospital from June 2013 to December 2018.Between-group comparisons were performed using the chi-squared,Kaplan-meier method was used for survival analysis.log-rank method was used for univariate analysis,and COX proportional hazard model was used for multivariate analysis.Results:PGI-DLBCL patients had late staging,higher lactate dehydrogenase(LDH),more combined surgical treatment,and less radiotherapy compared with PN-DLBCL.Univariate analysis suggested that age,LDH,IPI score were prognostic factors for PGI-DLBCL.Age,double expressors(DE),LDH,IPI score,KI67%,stagingwere the influencing factors for PN-DLBCL.COX multivariate analysis indicated that age≥60 years、abnormal LDH were independent prognostic factorsfor PGI-DLBCL,while IPI≥3 scores,KI67≥70% were independent prognostic factors for PN-DLBCL.Conclusion:The early diagnosis rate of PGI-DLBCL patients should be improved.In terms of treatment,a comprehensive treatment regimen can be formulated according to the independent prognostic factors of age and LDH,and the goal is to exceed the prognosis of PN-DLBCL.