Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
Eur J Haematol. 2011 Jul;87(1):28-36. doi: 10.1111/j.1600-0609.2011.01632.x.
Surgical resection is considered a crucial treatment in patients with primary colonic lymphoma, but combining surgery with chemotherapy has provided additional therapeutic benefits in some studies. To further explore the optimal therapeutic approach in different clinical scenarios, we reviewed cases with localized large-cell lymphoma and analyzed the factors related to the outcomes.
The 74 cases diagnosed between February 1979 and October 2010 were retrospectively reviewed for clinical features, laboratory findings, and pathological diagnosis. The outcomes were correlated with their demographics and different treatment modalities.
Of the 74 cases, only the patients who had complete tumor resection had significantly improved progression-free survival (PFS). The patients treated with resection and chemotherapy had better overall survival (OS) and PFS than those treated with resection alone. The OS and PFS of the patients who were treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy without surgery were similar to those of patients treated with CHOP and resection, but the patients treated with resection followed by cyclophosphamide, vincristine, and prednisone (COP) chemotherapy had significantly better OS and PFS than the patients treated with COP chemotherapy alone. For patients with diffuse large B-cell lymphoma (DLBCL), rituximab-based chemotherapy with or without resection had similar OS and PFS.
We conclude that chemotherapy alone provides similar therapeutic effect compared with surgery and chemotherapy and that surgical resection can be spared if an endoscopic diagnosis could be made.
手术切除被认为是原发性结外淋巴瘤患者的重要治疗方法，但在一些研究中，手术联合化疗提供了额外的治疗益处。为了进一步探讨不同临床情况下的最佳治疗方法，我们回顾了局部大细胞淋巴瘤的病例，并分析了与结果相关的因素。
回顾性分析了 1979 年 2 月至 2010 年 10 月期间诊断的 74 例患者的临床特征、实验室检查和病理诊断。将结果与患者的人口统计学和不同的治疗方式相关联。
在 74 例患者中，只有完全切除肿瘤的患者无进展生存期（PFS）显著改善。接受手术联合化疗治疗的患者总生存期（OS）和 PFS 均优于单纯手术治疗的患者。未接受手术的环磷酰胺、多柔比星、长春新碱和泼尼松（CHOP）化疗患者的 OS 和 PFS 与接受 CHOP 和手术治疗的患者相似，但接受手术后环磷酰胺、长春新碱和泼尼松（COP）化疗的患者 OS 和 PFS 明显优于单独接受 COP 化疗的患者。对于弥漫性大 B 细胞淋巴瘤（DLBCL）患者，无论是否联合手术，利妥昔单抗为基础的化疗与 OS 和 PFS 相似。
我们的结论是，与手术联合化疗相比，单纯化疗具有相似的治疗效果，如果能够进行内镜诊断，可以避免手术切除。
