摘要
目的探讨原发性胃肠道淋巴瘤(PGIL)的临床病理特征,分析影响其生存预后的因素。方法以兰州大学第二医院2010年4月-2018年3月经手术或内镜活组织检查确诊的67例PGIL患者为研究对象,回顾性分析其临床特征与预后关系。结果67例PGIL患者发病中位年龄52岁,临床表现多为腹痛腹胀、恶心呕吐及消化道出血;原发性胃淋巴瘤(PGL)发病多在胃体部,原发性肠道淋巴瘤(PIL)发病多在回肠末端及回盲部;67例PGIL患者中Ⅰ~Ⅱ期28例,Ⅲ~Ⅳ期39例,病理类型以弥漫性大B细胞淋巴瘤最常见;67例PGIL患者1、3、5年总生存率分别为79.0%、75.0%、60.0%。单因素分析显示Ⅲ~Ⅳ期、合并B症状、肠道发病、T细胞表型、单纯手术、乳酸脱氢酶(LDH)及β2微球蛋白水平升高、国际预后指数(IPI)危险等级评分>2分与预后不良相关;多因素分析显示肠道发病、单纯手术、高水平LDH及IPI危险等级评分增加是影响预后的独立危险因素。结论PGIL多发生在胃体部,主要病理类型为B细胞淋巴瘤,其预后整体好于T细胞淋巴瘤。PGL的治疗以化学治疗为主,PIL因急腹症多见常需合并外科手术治疗,但单纯手术预后欠佳。
Objective To summarize the clinical manifestation,pathological features of 67 cases with primary gastrointestinal lymphoma(PGIL)and investigate their prognostic factors.Methods The clinical data of67 PGIL patients diagnosed in the Second Hospital of Lanzhou University between April 2010 to March2018 were analyzed retrospectively.Restults With a median age of 52 years of the 67 cases with PGIL;the majority of clinical manifestation were abdominal discomfort,nausea and vomiting,hemorrhage of digestive tract;the most frequent site of PGL was the gastric body,while the ileum was the most common site to PIL,especially in terminal ileum and ileocecum;28 patients were stageⅠ~Ⅱand 39 were stageⅢ~Ⅳ;the most common pathologic types was diffuse large B cell lymphoma.1-year,3-year and 5-year overall survival were79.0%,75.0%,60.0%.The univariate analysis revealed thatⅢ~Ⅳ,B syptomps,intestinal involvement,T cell phenotype,sole surgery treatment,high level of LDH andβ2-M,IPI>2 were associated with poor prognosis;the multivariate analysis indicated that intestinal involvement,sole surgery treatment,high level of LDH and IPI>2 were the significant independent prognostic factors.Conclusion PGIL mostly occurs in the gastric body,B cell lymphoma is the most common pathologic type with the better overall prognosis than Tcell type.Chemotherapy is still the first-line treatment regimen for PGL,while PIL often needs surgical treatment because of more complications,but pure surgery usually demonstrates poor prognosis.
作者
穆善善
李言鹏
谢凯
王海燕
张耀平
黄晓俊
Mu Shan-shan;Li Yan-peng;Xie Kai;Wang Hai-yan;Zhang Yao-ping;Huang Xiao-jun(Department of Gastroenterology,The Second Hospital of Lanzhou University,Lanzhou 730030,China)
出处
《兰州大学学报（医学版）》
CAS
2020年第5期37-43,共7页
Journal of Lanzhou University（Medical Sciences）
基金
国家重点研究发展计划项目(2016YFC1303601)。
关键词
原发性胃肠道淋巴瘤
临床特征
治疗
预后
影响因素
primary gastrointestinal lymphoma
clinical feature
treatment
prognosis
prognostic factor
