摘要
目的探讨人类免疫缺陷病毒(HIV)相关型Burkitt淋巴瘤的临床特征和CT影像特征,分析其与预后的相关性。方法收集国内多医学中心56例HIV阳性Burkitt淋巴瘤初次治疗前的临床和CT影像资料,男51例,女5例,平均年龄(42.87±12.63)岁。56例病人初次治疗前均行CT平扫检查,54例同时行增强CT扫描。根据Ann Arbor分期将病人分为2组,早期组(Ⅰ~Ⅱ期)14例,晚期组(Ⅲ~Ⅳ期)42例。由2名医师提取CT特征,分析国际预后指数(IPI)评分,同时定期随访病人并记录总生存时间(OS)。采用卡方检验比较2组间CT影像特征及受累淋巴区域。采用Cox单因素和多因素回归分析潜在预后因子。采用Kaplan-Meier法和log-rank检验对OS的独立预测因子进行生存分析,并绘制生存曲线。结果56例病人中,43例(76.8%)肿瘤边界不清,32例(57.1%)存在融合征象,17例(30.3%)病变有坏死,31例(55.3%)有巨块病变,21例(37.5%)CT平扫密度不均匀。41/54例(75.9%)增强CT呈不均匀强化。最常累及腋窝、腹部和头颈淋巴区域,脾受累极少见;最常累及腹部脏器(胰腺为著),其次为肺,其他少见;最常外侵组织为肌肉和皮肤,其次为骨。晚期组病人腹膜和腹膜后淋巴受累比例高于早期组,肿瘤边界不清的比例也高于早期组(均P<0.05)。与OS有关的独立预测因子为IPI评分、累及肺、累及肝脏、肿瘤有融合征象及CT增强扫描病变呈不均匀强化。Kaplan-Meier生存曲线分析显示,IPI评分3~5分者较0~2分者死亡风险增加,肺和肝脏受累、CT增强扫描呈不均匀强化以及存在病变融合征象者的死亡风险均增加。结论HIV相关型Burkitt淋巴瘤的部分CT影像特征与OS相关,IPI评分和CT影像特征有利于预测病人的预后。
Objective To explore the clinical and CT features of HIV-related Burkitt lymphoma and their correlation with prognosis.Methods The clinical and CT imaging data of 56 cases of HIV-positive Burkitt lymphoma before initial treatment were collected from multiple medical centers in China.There were 51 males and 5 females,with an average age of(42.87±12.63)years old.All of 56 patients underwent plain CT scan before initial treatment,and 54 patients underwent enhanced CT scan at the same time.According to Ann Arbor staging,patients were divided into two groups,early group(stagesⅠ-Ⅱ)(n=42)and advanced group(stagesⅢ-Ⅳ)(n=42).Two doctors extracted CT features,analyzed the International Prognostic Index(IPI)score.The patients were regularly followed up and the overall survival times(OS)were recorded.The chi-square test was used to compare the CT imaging features and the extent of lymph node involvement between the two groups.Cox univariate and multivariate regressions were used to analyze potential prognostic factors.Kaplan-Meier method and log-rank test were used to analyze the independent prognostic factor,and survival curves were plotted simultaneously.Results Among the 56 patients,43(76.8%)had ill-defined tumors,32(57.1%)had fusion signs,17(30.3%)had necrotic lesions,31(55.3%)had bulky lesions,and 21 cases(37.5%)had uneven density on CT plain scan.There were 41/54 cases(75.9%)showed heterogeneous enhancement on enhanced CT.It commonly invaded the axilla,abdomen,and head and neck lymphatic regions,and rarely the spleen.The most invaded organs were abdominal organs(mainly the pancreas),followed by the lungs,and others were rare.The most invaded tissues were muscle and skin,followed by bone.The proportion of peritoneal,retroperitoneal and pelvic lymph node involvement in the advanced group was higher than that in the early group,and the proportion of tumors with unclear boundaries was also higher than that in the early group(all P<0.05).Independent predictors of OS were IPI score,lung involvement,liver involvement
作者
江冬梅
王杏
夏爽
李宏军
刘晋新
施欲新
李雪芹
JIANG Dongmei;WANG Xing;XIA Shuang;LI Hongjun;LIU Jinxin;SHI Yuxin;LI Xueqin(Department of Radiation Oncology,Tianjin First Central Hospital,Tianjin 300192,China;Department of Radiology,Youan Hospital Affiliated of Capital Medical University;Department of Radiology,Tianjin First Central Hospital;Department of Radiology,Eighth People爷s Hospital of Guangzhou;Department of Radiology,Shanghai Public Health Center,Affiliated of Fudan University)
出处
《国际医学放射学杂志》
北大核心
2022年第1期32-38,共7页
International Journal of Medical Radiology
基金
国家自然科学基金项目(81771806,61936013)。
