原发性胃弥漫性大 B 细胞淋巴瘤（DLBCL）：预后因素分析及 FDG-PET 扫描的价值。
Primary gastric diffuse large B-cell Lymphoma (DLBCL): analyses of prognostic factors and value of pretreatment FDG-PET scan.
机构信息
Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan.
出版信息
Eur J Haematol. 2010 Jun;84(6):493-8. doi: 10.1111/j.1600-0609.2010.01426.x. Epub 2010 Feb 9.
OBJECTIVES
We report a single institution experience with gastric diffuse large B-cell lymphoma (DLBCL) in an attempt to evaluate the roles of different treatment modalities, to assess the value of pretreatment positron emission tomography (PET) scan, and to identify potential prognostic factors.
METHODS
Among 384 patients diagnosed with DLBCL between 1995 and 2008, 75 patients had primary gastric DLBCL and were reviewed and analyzed.
RESULTS
The median age was 66. International prognostic index (IPI) risk was low in 52%, low-intermediate in 23%, high-intermediate in 9%, and high in 16%. Pretreatment PET scan was highly sensitive in detecting gastric lesions except stage I gastric DLBCL without detectable mass by CT or gastroscopy. As a general rule, patients with limited-stage disease were treated with three times of CHOP (with or without rituximab) and radiotherapy, and those with advanced-stage disease were treated with eight cycles of CHOP (with or without rituximab), and radiotherapy was given to residual diseases after chemotherapy. Three-year overall survival (OS) rate was 78%. Multivariate analysis revealed that low albumin, hemoglobin <12.0 g/dL, and treatment without rituximab were independently associated with shorter OS. Low albumin, hemoglobin <12.0 g/dL,and advanced stage were independently associated with shorter progression-free survival.
CONCLUSION
We showed the survival benefit of rituximab and potential prognostic value of pretreatment hemoglobin and serum albumin levels in gastric DLBCL.
目的
我们报告了一家机构在胃弥漫性大 B 细胞淋巴瘤（DLBCL）方面的经验，旨在评估不同治疗方式的作用，评估治疗前正电子发射断层扫描（PET）的价值，并确定潜在的预后因素。
方法
在 1995 年至 2008 年间诊断为 DLBCL 的 384 例患者中，75 例患者为原发性胃 DLBCL，对其进行了回顾性分析。
结果
中位年龄为 66 岁。国际预后指数（IPI）风险低者占 52%，低-中危者占 23%，中-高危者占 9%，高危者占 16%。治疗前 PET 扫描在检测胃病变方面具有高度敏感性，除 CT 或胃镜检查无法检测到肿块的 I 期胃 DLBCL 外。一般来说，局限性疾病患者接受 3 次 CHOP（含或不含利妥昔单抗）联合放疗，晚期疾病患者接受 8 次 CHOP（含或不含利妥昔单抗）化疗，化疗后给予残留病灶放疗。3 年总生存率（OS）为 78%。多因素分析显示，低白蛋白、血红蛋白<12.0 g/dL 和未使用利妥昔单抗与 OS 缩短独立相关。低白蛋白、血红蛋白<12.0 g/dL 和晚期与无进展生存期缩短独立相关。
结论
我们表明了利妥昔单抗在胃 DLBCL 中的生存获益，以及治疗前血红蛋白和血清白蛋白水平的潜在预后价值。
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