Cortelazzo Sergio, Rossi Andrea, Oldani Elena, Motta Teresio, Giardini Roberto, Zinzani Pier Luigi, Zucca Emanuele, Gomez Henry, Ferreri Andrés J M, Pinotti Graziella, Chini Claudio, Devizzi Liliana, Gianni Alessandro M, Cavalli Franco, Barbui Tiziano
Divisione di Ematologia e Servizio di Anatomia Patologica e Citologia, Ospedali Riuniti di Bergamo, Bergamo, Italy.
Br J Haematol. 2002 Jul;118(1):218-28. doi: 10.1046/j.1365-2141.2002.03613.x.
We have previously reported on the efficacy of a modified International Prognostic Index (MIPI) in predicting the outcome of patients with primary gastric lymphoma. This prompted the retrospective analysis of a large series of patients with primary intestinal lymphoma (PIL) of both diffuse large B-cell (DLCL) and low-grade (extranodal marginal zone B-cell lymphoma, MZL) histology. Clinical records of 122 patients with localized primary intestinal lymphoma of MZL (n=35) and DLCL (n=87) histology, confirmed by an ad hoc expert panel of pathologists, were reviewed. Forty-nine patients were treated with single therapy, while 72 received combined-modality treatment, which included surgery followed by a short-term chemotherapy. MIPI was included in a multivariate prognostic analysis for overall survival (OS) and event-free survival (EFS). Sixty-five patients (75%) with DLCL and 22 with MZL(65%) achieved complete remission. After a median follow-up of 42 months (range 6-163 months), 5-year estimates of OS and EFS were 68% and 50% for DLCL and 65% and 26% for MZL. OS varied according to MIPI, from, respectively, 86% and 87% for DLCL and MZL patients with 0-1 risk factor to 50% and 32% for patients with > 1 risk factor (P=0.01 and P=0.02). Similar results were obtained for EFS. Cox regression analysis showed an unfavourable MIPI to be the only independent predictor of shorter EFS. This retrospective study shows that stage-MIPI can be a reliable prognostic indicator for PIL of both low-grade MZL and diffuse large B-cell histology, enabling the early identification of patients at higher risk of failure.
我们之前曾报道过改良国际预后指数（MIPI）在预测原发性胃淋巴瘤患者预后方面的疗效。这促使我们对大量原发性肠道淋巴瘤（PIL）患者进行回顾性分析，这些患者的组织学类型包括弥漫性大B细胞淋巴瘤（DLCL）和低级别（结外边缘区B细胞淋巴瘤，MZL）。我们回顾了由一个特设病理专家小组确诊的122例局限性原发性肠道淋巴瘤患者的临床记录，其中MZL组织学类型患者35例，DLCL组织学类型患者87例。49例患者接受单一治疗，72例接受综合治疗，包括手术及短期化疗。MIPI被纳入总生存期（OS）和无事件生存期（EFS）的多因素预后分析。65例（75%）DLCL患者和22例（65%）MZL患者实现完全缓解。中位随访42个月（范围6 - 163个月）后，DLCL患者的5年OS和EFS估计值分别为68%和50%，MZL患者分别为65%和26%。OS根据MIPI有所不同，DLCL和MZL患者中，0 - 1个危险因素者的OS分别为86%和87%，>1个危险因素者分别为50%和32%（P = 0.01和P = 0.02）。EFS也得到了类似结果。Cox回归分析显示，不良MIPI是EFS较短的唯一独立预测因素。这项回顾性研究表明，分期MIPI对于低级别MZL和弥漫性大B细胞组织学类型的PIL可能是一个可靠的预后指标，能够早期识别失败风险较高的患者。
