摘要
目的探讨原发肠道恶性淋巴瘤（PIL）的临床特征、诊治方法和预后。方法回顾性分析1995年11月1日至2013年11月30日在北京大学肿瘤医院确诊的PIL患者病例资料。结果符合诊断条件的PIL患者99例，男65例，女34例，男女比为1．9：1，中位年龄50（12～90）岁。胃肠道非特异性症状为主要临床表现，其中腹痛67例（67．68％），最为常见，26例（26．26％）患者发病时伴随有急腹症。回肠原发和回盲部原发均为21例，是最常见的发病部位。经消化内镜活检后诊断的PIL仅24例（24．24％），依靠手术诊断的患者为69例（69．70％）。Ⅰ～Ⅱ期71例（71．72％），Ⅳ期28例（28．28％）。所有病例均为非霍奇金淋巴瘤，B细胞来源77例（77．78％），T细胞来源22例（22．22％）。其中最常见为弥漫大B细胞淋巴瘤（DLBCL），共55例（55．56％）；国际预后指数（IPI）评分0-1分60例。本组患者中位总生存（OS）期为100．0个月，5年OS率为53．50％。多因素分析显示，T细胞来源者预后差（P〈0．05）。74例患者进行了手术治疗，96例患者进行了全身化疗。手术联合化疗组和单纯化疗组的中位OS期分别为79．0个月和123．0个月，差异无统计学意义（P=-0．616）。结论PIL好发于男性，腹痛是其最常见的临床表现，回肠及回盲部为最常见的发病部位，相对来说PIL发病比较局限，但内镜检查确诊率低下；最常见的病理类型是DLBCL，T细胞来源是PIL预后不良的独立影响因素。手术仍然是PIL常用的诊断及治疗手段，且手术并未增加PIL患者的生存风险。
Objective To investigate the clinical features, diagnosis, treatment and prognosis of primary intestinal lymphoma （PIL）. Methods The characteristics, diagnosis, treatment methods, and follow-up outcomes of 99 PIL patients, diagnosed in Peking university cancer hospital between Nov. 1,1995 and Nov. 30, 2013. Results There were 65 males and 34 females with a median age of 50 years. The majority of clinical manifestation were non-specific gastrointestinal symptoms, 67.68% of cases presented abdominal pain, 26.26% with acute abdomen. The most common primary sites of ileum and ileoeecus were identified in 21 cases, respectively. The positive rate of endoscopic was only 24.24%, and 69 cases were diagnosed by operation. 71 patients （71.72%） were stageⅠ～Ⅱ and 28 patients （28.28%）were stage Ⅳ. Hodgkin＇ s lymphoma was not found in all patients. Of the 99 cases, 77 were B-cell origin （77.78%） and 22 were T-cell origin. 55 cases （55.56%） were diagnosed with diffuse large B cell lymphoma （DLBCL）. 60 cases presented IPI score 0-1 point. The median overall survival （OS） was 100,0 months, and 5 year overall survival （5y-OS） was 53.5%. By multiple-factors analysis, T-cell origin lymphoma was significantly correlated with poor prognosis （P 〈 0.05）. There was no difference of the median OS between the patients with operation and chemotherapy alone （79.0 vs 123.0 months, P=-0.616）. Conclusion PIL is commonly seen in males. Abdominal pain is the most common clinical manifestations and the most primary sites are ileum and ileocecus. The diagnosis value of the endoscopic is limited. DLBCL is the most common pathologic type of PIL. T- cell origin lymphoma is an independent prognostic factor for PIL. Surgery is still commonly used in the diagnosis and treatment of PIL, and the operation do not increase the risk of death of patients with PIL.
作者
平凌燕
宋玉琴
郑文
王小沛
谢彦
林宁晶
涂梅峰
应志涛
刘卫平
张晨
邓丽娟
朱军
Lingyan Song Yuqin Zheng Wen Wang Xiaopei Xie Yan Lin Ning]ing Tu Meifeng Ying Zhitao Liu Weiping Zhang Chen Deng Lo＇uan Zhu Jun.(Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research （Ministry of Education）, Peking University School of Clinical Oneology, Beijing Cancer Hospital, Beijing Institute for Cancer Research, Beij＇ing 100142, China)
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2017年第3期231-236,共6页
Chinese Journal of Hematology
关键词
肠道淋巴瘤
临床特征
治疗
预后
Intestinal lymphoma
Clinical features
Treatment
Prognosis
