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目的:分析胃弥漫大B细胞淋巴瘤(DLBCL)的临床特点和预后,以期更好的指导治疗。方法:回顾性收集1999年1月至2012年3月中国医学科学院肿瘤医院收治的初治、胃原发DLBCL患者的临床资料,分析其人口学特点、分期、病理诊断、并发症、治疗和预后等特征。结果:共计纳入研究患者126例,中位年龄49(16~81)岁,男女比例为68:58。病理诊断为单纯DLBCL 96例、MALT伴大B细胞转化27例、伴浆样细胞分化3例。早期患者114例(90.5%),其治疗方式包括单纯化疗37例、化疗+放疗39例、手术+化疗±放疗38例。中位随访48个月,全组患者PFS和OS分别为75.6%和82.7%,早期和晚期患者的PFS分别为77%和41.7%(P=0.005)。早期患者采用单纯化疗、化放疗联合和含手术治疗的PFS分别为67.3%、77.8%和77.8%(P=0.588)。国际预后指数(IPI)评分为0分、1分和>1分患者的PFS分别为85.4%,74.4%和55.6%(P=0.011)。Ⅰ期和Ⅱ期患者的PFS分别为81.2%和66.1%(P=0.018)。LDH正常和升高患者的PFS分别为86.6%和63.3%(P=0.006)。病理类型为单纯DLBCL和含有MALT成分、生发中心(GCB)和非生发中心(non-GCB)、年龄>60岁等与预后无关。结论:早期病变比例占胃原发DLBCL患者的绝大多数。早期患者预后良好,手术切除并不能提高疗效。早期患者中IPI>1分、LDH升高和临床分期Ⅱ期提示预后不良。
Objective: To analyze the clinical features and prognosis of gastric diffuse large B cell lymphoma (DLBCL) in order to guide the treatment better. Methods: The clinical data of primary and primary DLBCL patients treated at Cancer Hospital of Chinese Academy of Medical Sciences from January 1999 to March 2012 were retrospectively collected. The demographic characteristics, staging, pathological diagnosis, complications, treatment and prognosis were analyzed. And so on. Results: A total of 126 patients were included in the study, with a median age of 49 (16-81) years, with a male to female ratio of 68:58. Pathological diagnosis of simple DLBCL in 96 cases, MALT with large B cell transformation in 27 cases, with plasma-like cell differentiation in 3 cases. In the early stage, 114 cases (90.5%) were treated by chemotherapy, including 37 cases of simple chemotherapy, 39 cases of chemotherapy and radiotherapy, and 38 cases of surgery and chemotherapy plus radiotherapy. At a median follow-up of 48 months, PFS and OS were 75.6% and 82.7% for the whole group, PFS was 77% and 41.7% for early and late patients, respectively (P = 0.005). Early patients treated with chemotherapy alone, combined with radiotherapy and surgery PFS were 67.3%, 77.8% and 77.8% (P = 0.588). The PFS for the International Prognostic Index (IPI) score of 0, 1 and> 1 were 85.4%, 74.4% and 55.6%, respectively (P = 0.011). PFS was 81.2% and 66.1% in stage I and stage II patients, respectively (P = 0.018). The PFS of patients with normal and elevated LDH were 86.6% and 63.3%, respectively (P = 0.006). The pathological type was simple DLBCL and contained MALT component, germinal center (GCB) and non-germinal center (non-GCB), age> 60 years and so had no prognosis. Conclusion: The proportion of early lesions accounts for the vast majority of patients with primary DLBCL. Early patients with good prognosis, surgical excision and can not improve the efficacy. Early patients with IPI> 1 point, elevated LDH and clinical stage II suggest a poor prognosis.