摘要
目的探讨原发肠道非霍奇金淋巴瘤(PI-NHL)患者的临床特征、治疗方式及预后因素。方法收集2005-01-01-2020-12-31山西医科大学附属肿瘤医院196例PI-NHL患者临床资料。根据不同治疗方式将患者分为单纯化疗组(47例)、单纯手术组(17例)和联合组(手术联合化疗或放疗组,132例)。回顾性分析其临床特征和生存状况,用Kaplan-Meier法及Cox回归模型进行生存分析。结果196例PI-NHL患者中男132例,女64例,中位年龄55岁。腹痛为常见临床表现(146例,74.5%);27例患者发病时表现为严重肠道并发症;弥漫性大B细胞淋巴瘤(DLBCL)为常见病理类型(128例,65.3%);149例患者国际预后指数(IPI)评分为0~2分。所有患者中位随访时间为59个月;中位总生存期(OS)为44个月;中位无进展生存期(PFS)为18个月。单因素分析结果显示,年龄、病理类型、肠穿孔、肠出血、β2微球蛋白(β2-MG)水平、B症状、Lugano分期、美国东部肿瘤协作组(ECOG)评分、IPI评分和治疗方式是影响患者OS及PFS的预后因素,均P<0.05。乳酸脱氢酶(LDH)水平仅对OS有影响,χ^(2)=4.226,P=0.040。多因素分析结果显示,肠穿孔(HR=0.320,95%CI:0.149~0.689,P=0.004)、β2-MG水平(HR=0.524,95%CI:0.343~0.800,P=0.003)和治疗方式(HR=1.401,95%CI:1.048~1.871,P=0.023)是影响患者PFS的独立预后因素;肠穿孔(HR=0.201,95%CI:0.086~0.470,P<0.001)、β2-MG水平(HR=0.529,95%CI:0.334~0.838,P=0.007)、治疗方式(HR=1.702,95%CI:1.237~2.343,P=0.001)及IPI评分(HR=2.215,95%CI:1.184~4.144,P=0.013)是影响患者OS的独立预后因素。联合组OS及PFS优于单纯手术组,但与单纯化疗组差异无统计学意义。结论IPI高危组、伴肠穿孔并发症、β2-MG升高均是PI-NHL患者预后不良因素,手术不能明显改善患者预后,化疗仍然是PI-NHL患者治疗主要策略。
Objective To investigate the clinical features,treatment and prognostic factors of primary intestinal non-Hodgkin's lymphoma(PI-NHL).Methods The clinical data of 196patients with PI-NHL in Affiliated Tumor Hospital of Shanxi Medical University from January 1,2005to December 31,2020were collected.Patients were divided into chemotherapy group(47cases),surgery group(17cases)and combination group(surgery combined with chemotherapy or radiotherapy,132cases)according to different treatment regimens.The clinical features and survival situation of the patients were retrospectively analyzed.Kaplan-Meier method and Cox regression model were used for survival analysis.Results There were 196patients with PI-NHL,including 132males and 64females.The median age was 55years.Abdominal pain was the most common clinical presentation(146cases,74.5%),and 27patients presented with severe intestinal complications.Diffuse large B-cell lymphoma(DLBCL)was the most common pathological type(128cases,65.3%).Totally 149 cases presented Internation Prognosis Index(IPI)score of 0-2.The median follow-up time was 59months.The median overall survival(OS)was 44months,and the median progression-free survival(PFS)was 18months.The results of univariate analysis showed that the prognostic factors affecting OS and PFS included age,pathological type,intestinal perforation,intestinal hemorrhage,β2-MG level,B symptom,Lugano stage,ECOG score,IPI score and treatment regimens(P<0.05).The level of lactate dehydrogenase(LDH)only affected OS(χ^(2)=4.226,P=0.040).The multivariate analysis indicated that intestinal perforation(HR=0.320,95%CI:0.149-0.689,P=0.004),β2-MG level(HR=0.524,95%CI:0.343-0.800,P=0.003)and treatment(HR=1.401,95%CI:1.048-1.871,P=0.023)were independent prognostic factors affecting PFS.Intestinal perforation(HR=0.201,95%CI:0.086-0.470,P<0.001),β2-MG level(HR=0.529,95%CI:0.334-0.838,P=0.007),treatment(HR=1.702,95%CI:1.237-2.343,P=0.001)and IPI score(HR=2.215,95%CI:1.184-4.144,P=0.013)were independent prognostic factors affecting OS.Both OS a
作者
张苗苗
王列样
赵志强
苏丽萍
ZHANG Miaomiao;WANG Lieyang;ZHAO Zhiqiang;SU Liping(Department of Hematology,Affiliated Tumor Hospital of Shanxi Medical University,Taiyuan030013,China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2023年第8期483-489,共7页
Chinese Journal of Cancer Prevention and Treatment
关键词
肠道
非霍奇金淋巴瘤
临床特征
预后
治疗
intestinal
non-Hodgkin's lymphoma
clinical features
prognosis
treatment.
