Stein R S, Greer J P, Flexner J M, Hainsworth J D, Collins R D, Macon W R, Cousar J B
Department of Medicine (Division of Hematology), Vanderbilt University Medical Center, Nashville, TN 37232.
J Clin Oncol. 1990 Aug;8(8):1370-9. doi: 10.1200/JCO.1990.8.8.1370.
We reviewed the clinical and pathologic features in 186 patients with large-cell lymphomas seen at Vanderbilt University Hospital between 1970 and 1986. Ninety-two cases (49%) were large noncleaved-cell lymphoma (LNCCL), 61 cases (33%) were large-cleaved-cell lymphoma (LCCL), 17 cases (9%) were peripheral T-cell lymphoma (PTCL), and 16 cases (9%) were immunoblastic sarcoma of B cells (IBS-B). These subsets of large-cell lymphoma did not differ with respect to median age, distribution by stage, or incidence of bone marrow involvement. Significant differences between groups were noted with regard to male:female ratio, incidence of symptoms, incidence of extranodal disease, and pattern of adenopathy. However, when LCCL was excluded from the analysis, none of these differences were significant. By univariate analysis, age, stage, marrow involvement, extranodal disease, B symptoms, elevated serum lactic dehydrogenase (LDH), and diffuse pattern were unfavorable prognostic features in large-cell lymphoma. However, when cases were stratified by cell of origin, nodular versus diffuse pattern was of no prognostic significance. Nodularity was favorable only because 71% of nodular and nodular-diffuse cases were LCCL, while the majority of diffuse cases were LNCCL. Although IBS-B is considered a "high-grade" lymphoma, we found no evidence for inferior survival in these patients compared with LNCCL or LCCL. In fact, survival was better in IBS-B than in LNCCL or LCCL, although this difference was not significant. However, survival was significantly inferior in PTCL (median, 11 months) compared with the other subsets of large-cell lymphoma (median, 46 months; P = .038, log-rank test). Since the association of PTCL and an inferior survival has most often been noted in the context of "second-generation" chemotherapy, we believe that this association may be therapy-dependent and may be minimized by the use of more aggressive chemotherapy regimens.
我们回顾了1970年至1986年间在范德比尔特大学医院就诊的186例大细胞淋巴瘤患者的临床和病理特征。92例（49%）为大无裂细胞淋巴瘤（LNCCL），61例（33%）为大裂细胞淋巴瘤（LCCL），17例（9%）为外周T细胞淋巴瘤（PTCL），16例（9%）为B细胞免疫母细胞肉瘤（IBS-B）。这些大细胞淋巴瘤亚组在中位年龄、分期分布或骨髓受累发生率方面并无差异。在男女比例、症状发生率、结外疾病发生率和淋巴结病模式方面，各亚组间存在显著差异。然而，当将LCCL排除在分析之外时，这些差异均无统计学意义。单因素分析显示，年龄、分期、骨髓受累、结外疾病、B症状、血清乳酸脱氢酶（LDH）升高和弥漫性模式是大细胞淋巴瘤的不良预后特征。然而，当按细胞来源对病例进行分层时，结节性与弥漫性模式并无预后意义。结节性预后较好只是因为71%的结节性和结节-弥漫性病例为LCCL，而大多数弥漫性病例为LNCCL。尽管IBS-B被认为是一种“高级别”淋巴瘤，但我们并未发现这些患者的生存率低于LNCCL或LCCL的证据。事实上，IBS-B的生存率高于LNCCL或LCCL，尽管这种差异并不显著。然而，PTCL的生存率（中位生存期11个月）明显低于其他大细胞淋巴瘤亚组（中位生存期46个月；P = 0.038，对数秩检验）。由于PTCL与较差生存率之间的关联最常出现在“第二代”化疗的背景下，我们认为这种关联可能与治疗有关，通过使用更积极的化疗方案可能会将其影响降至最低。
