Department of Hematology, Hospital Clínic, Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.
Leuk Lymphoma. 2010 Jul;51(7):1225-32. doi: 10.3109/10428194.2010.483301.
To study the main clinico-biological characteristics and the outcome of patients with diffuse large B-cell lymphoma (DLBCL) according to the primary site (nodal vs. extranodal), we included 262 patients consecutively diagnosed with DLBCL in a single institution, 5 years before and after immunochemotherapy was considered as the standard treatment. Altogether 116 patients received CHOP (cyclophosphamide, adriamycin, vincristine, and prednisone) and 146 rituximab plus CHOP (R-CHOP). The primary site was the lymph node in 140 patients (53%), Waldeyer's ring (WR) in 22, gastrointestinal (GI) in 33, and other extranodal in 67. The addition of rituximab significantly improved the CR rate in nodal, but not in extranodal, lymphomas. Patients receiving R-CHOP showed higher OS than those treated with CHOP alone (5-year OS: 71% vs. 48%). This difference was maintained in primary nodal (5-year OS: 69% vs. 37%, p < 0.0001), but was not observed in primary extranodal (75% vs. 65%, p = 0.45) lymphomas. The IPI, treatment, and primary site were the main variables for OS in multivariate analysis. In nodal cases, IPI and treatment maintained value, whereas only IPI predicted OS in extranodal cases. In conclusion, immunochemotherapy treatment dramatically improved the outcome of patients with nodal DLBCL; however, its effect was less in primary extranodal cases, so the prognosis of patients with nodal and extranodal lymphomas has been equalized in the rituximab era.
为了研究根据原发部位（淋巴结与结外）不同的弥漫性大 B 细胞淋巴瘤（DLBCL）患者的主要临床生物学特征和预后，我们在免疫化疗被认为是标准治疗的 5 年前和 5 年后，连续纳入了一家机构的 262 例确诊为 DLBCL 的患者。共有 116 例患者接受了环磷酰胺、多柔比星、长春新碱和泼尼松（CHOP）治疗，146 例患者接受了利妥昔单抗联合 CHOP（R-CHOP）治疗。140 例患者（53%）的原发部位为淋巴结，22 例为咽淋巴环（WR），33 例为胃肠道（GI），67 例为其他结外部位。利妥昔单抗的加入显著提高了淋巴结和结外淋巴瘤的完全缓解率。接受 R-CHOP 治疗的患者的总生存率（OS）高于单独接受 CHOP 治疗的患者（5 年 OS：71% vs. 48%）。这种差异在原发淋巴结（5 年 OS：69% vs. 37%，p<0.0001）中保持，但在原发结外（75% vs. 65%，p=0.45）中没有观察到。多因素分析显示，国际预后指数（IPI）、治疗和原发部位是 OS 的主要变量。在淋巴结病例中，IPI 和治疗仍然有价值，而在结外病例中只有 IPI 预测 OS。总之，免疫化疗治疗显著改善了淋巴结 DLBCL 患者的预后；然而，在原发结外病例中效果较小，因此在利妥昔单抗时代，淋巴结和结外淋巴瘤患者的预后已经相当。
