摘要
目的分析原发性胃淋巴瘤(PGL)组织分型及围手术期相关因素对预后的影响。方法对中国医科大学附属第一医院胃肠肿瘤外科1988年9月至2011年7月期间收治的53例PGL患者的临床病理资料进行回顾性分析,通过Kaplan-Meier生存曲线计算累积生存率,采用Log-rank检验单因素分析和Cox模型多因素分析分析其临床特征及围手术期相关因素对预后的影响,并通过单因素分析法分析不同病理分型,其影响预后相关因素是否存在差异。结果 53例PGL患者发病年龄21～78岁(平均年龄54岁,中位年龄58岁)。本组病例组织分型:黏膜相关淋巴组织淋巴瘤(MALT)占64.2%(34/53)、弥漫性大B细胞淋巴瘤(DLBCL)22.6%(12/53)。Ann Arbor临床分期:ⅠE期22例(41.5%,22/53)、ⅡE期19例(35.8%,19/53)、ⅢE期1例(1.9%,1/53)、ⅣE期10例(18.9%,10/53)。随访资料完整的53例患者中,1、3、5年生存率分别为81.1%、47.2%、32.1%,总体中位生存期为35个月。单因素分析显示:影响预后的相关因素中性别(P=0.021)、年龄(P=0.028)、肿瘤大小(P=0.004)、手术根治度(P <0.001)、侵犯脏器(P <0.001)、病理组织分型(P=0.006)、Ann Arbor分期(P=0.029)方面差异具有统计学意义;多因素分析显示:手术根治度(OR=3.611)、病变组织分型(OR=1.729)、Ann Arbor分期(OR=1.509)是影响预后的独立因素。影响MALT预后相关因素中性别(P=0.028)、手术根治度(P <0.001)、侵犯脏器(P <0.001)以及Ann Arbor分期(P=0.003)方面差异具有统计学意义。而DLBCL预后与患者胃肠道炎性病变、溃疡等良性疾病史存在相关性(P=0.003)。结论肿瘤根治度、侵犯脏器、原发性胃淋巴瘤的组织分型是影响原发性胃淋巴瘤预后的独立因素;患者性别、手术根治度、侵犯脏器、Ann Arbor分期与MALT的预后存在相关性;患者胃肠道疾病史与DLBCL预后存在相关性。
Objective To analyze the clinical and pathological characteristics and prognostic factors of primary gastric lymphoma.Methods The clinical data of 53 patients with primary gastric lymphoma were retrospectively analyzed from September 1988 to July 2011 at the First Hospital of China Medical University.Kaplan-Meier analysis,Log-rank test,Cox regression analysis,and univariate analysis were used to examine whether there was a difference in prognostic factors in different pathological types.Results There were 34 males and 19 females,and their age was 21 to 78 years,with an average age of 54 years and a median age of 58 years.There were 4 cases of Hodgkin's lymphoma,34 cases of mucosaassociated lymphoid tissue(MALT)lymphoma,12 cases of diffuse large B-cell lymphoma(DCBCL),and 3 cases of lymphoid plasma cell lymphoma.The most common histological type was MALT lymphoma(64.2%),and most patients had Ann Arbor stages IE(41.5%)and IIE(31.7%)diseases.The 1-,3-,and 5-year survival rates were 81.1%,47.2%,and 32.1%,respectively.The median overall survival time was 35.0 months.Univariate analysis showed that gender(P=0.021),age(P=0.028),tumor size(P=0.004),tumor resection(P<0.001),organ invasion(P<0.001),histological type(P=0.006),and Ann Arbor stage(P=0.029)were significantly correlated with the prognosis.Multivariable analysis demonstrated that tumor resection(OR=3.611),histological type(OR=1.729),and Ann Arbor stage(OR=1.509)were independent prognostic factors.Moreover,the prognosis of MALT lymphoma was correlated with gender(P=0.028),tumor resection(P<0.001),organ invasion(P<0.001),and Ann Arbor stage(P=0.003).For DLBCL patients,chronic gastric disease were correlated with the prognosis(P=0.003).Conclusion Tumor resection,histological type,and Ann Arbor stage are independent prognostic factors.The prognosis of MALT lymphoma correlates with gender,tumor resection,organ invasion,and Ann Arbor stage.For DLBCL lymphoma patients,history of chronic gastric disease correlates with the prognosis.
作者
杜楠
朱志
徐惠绵
Du Nan;Zhu Zhi;Xu Huimian(Department of Gastrointestinal Oncological Surgery,the First Hospital of China Medical University,Shenyang 110000,China)
出处
《中华临床医师杂志（电子版）》
CAS
2018年第4期204-211,共8页
Chinese Journal of Clinicians(Electronic Edition)
基金
国家自然科学基金(81302129)
关键词
原发性胃淋巴瘤
诊断
治疗
预后
Primary gastric lymphoma
Diagnosis
Treatment
Prognosis
