骨淋巴瘤的临床特征及预后因素：聚焦原发性骨大B细胞淋巴瘤多灶性骨受累的临床意义
Clinical characteristics and prognostic factors of bone lymphomas: focus on the clinical significance of multifocal bone involvement by primary bone large B-cell lymphomas.
作者信息
Wu Huanwen, Bui Marilyn M, Leston Douglas G, Shao Haipeng, Sokol Lubomir, Sotomayor Eduardo M, Zhang Ling
机构信息
Department of Hematopathology and Laboratory Medicine, H, Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
出版信息
BMC Cancer. 2014 Dec 2;14:900. doi: 10.1186/1471-2407-14-900.
BACKGROUND
Malignant bone lymphoma can be classified as primary (PBL) or secondary (SBL) bone lymphoma. However, the clinico-pathological characteristics and prognostic factors of PBL versus SBL have not yet been well defined. Whether lymphoma with multifocal bone involvement should be considered as stage IV PBL or SBL still remain controversial throughout the literature.
METHODS
In this study, we retrospectively reviewed 127 patients with bone lymphoma diagnosed from 1998 to 2013 at the Moffitt Cancer Center. Patients were classified as PBL (81 cases) and SBL (46 cases) using the 2013 WHO Classification of Bone/Soft Tissue Tumors and PBL patients were further subdivided into: 1) PBL with unifocal bone disease (uPBL, 46 cases), 2) PBL with multifocal bone involvement (mPBL, 35 cases). Patient characteristics, survival, and prognostic factors were analyzed.
RESULTS
Diffuse large B-cell lymphoma (DLBCL) was the most common histological subtype in all three groups (37/46 of uPBL, 23/35 of mPBL, 23/46 of SBL). B symptoms, lymph node involvement, and bone marrow involvement were found to be more common in mPB-DLBCL and SB-DLBCL groups than in the uPB-DLBCL group. Femur was found to be the most common affected site in uPB-DLBCL patients, while spine was most commonly involved in the other two groups. Survival analysis indicated that uPBL-DLBCL patients had a significantly better progression-free survival (PFS) and overall survival (OS) than those in the other two groups (P<0.05). We also found by univariate analysis that multifocality, and stage IV were significantly poor prognostic factors for both PFS and OS in PBL patients. Using multivariate analysis, multifocality remained an independent prognostic factor for both PFS and OS (P=0.0117, RR: 3.789, 95% CI: 1.275-11.256).
CONCLUSION
Overall, our results suggest that mPBL is more similar to SBL in characteristics and survival rather than uPBL, and thus should be better classified and treated as SBL.
背景
恶性骨淋巴瘤可分为原发性（PBL）或继发性（SBL）骨淋巴瘤。然而，PBL与SBL的临床病理特征及预后因素尚未明确界定。在整个文献中，多灶性骨受累的淋巴瘤应被视为IV期PBL还是SBL仍存在争议。
方法
在本研究中，我们回顾性分析了1998年至2013年在莫菲特癌症中心确诊的127例骨淋巴瘤患者。根据2013年世界卫生组织骨/软组织肿瘤分类，将患者分为PBL（81例）和SBL（46例），PBL患者进一步细分为：1）单灶性骨病的PBL（uPBL，46例），2）多灶性骨受累的PBL（mPBL，35例）。分析患者特征、生存情况及预后因素。
结果
弥漫性大B细胞淋巴瘤（DLBCL）是所有三组中最常见的组织学亚型（uPBL组46例中的37例，mPBL组35例中的23例，SBL组46例中的23例）。发现B症状、淋巴结受累和骨髓受累在mPB-DLBCL组和SB-DLBCL组中比在uPB-DLBCL组中更常见。发现股骨是uPB-DLBCL患者中最常受累的部位，而脊柱在其他两组中最常受累。生存分析表明，uPBL-DLBCL患者的无进展生存期（PFS）和总生存期（OS）明显优于其他两组（P<0.05）。我们还通过单因素分析发现，多灶性和IV期是PBL患者PFS和OS的显著不良预后因素。使用多因素分析，多灶性仍然是PFS和OS的独立预后因素（P=0.0117，RR：3.789，95%CI：1.275-11,256）。
结论
总体而言，我们的结果表明，mPBL在特征和生存方面更类似于SBL而非uPBL，因此应更好地归类为SBL并按SBL进行治疗。
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