Luo Bihua, Huang Jianqing, Yan Zixun, Zhao Weili, Wang Li
Department of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
Zhonghua Xue Ye Xue Za Zhi. 2015 Apr;36(4):277-81. doi: 10.3760/cma.j.issn.0253-2727.2015.04.003.
To analyze the clinical features, therapeutic methods and prognosis of primary breast lymphoma (PBL).
Twenty-one PBL patients treated in Ruijin Hospital from January 2003 to December 2013 were included in this study, with 17 diffuse large cell lymphoma (DLBCL), 1 mucosa-associated lymphoid tumor (MALT), 1 follicular lymphoma (FL), 1 Burkitt lymphoma and 1 subcutaneous peniculitis T-cell lymphoma according to the WHO 2008 classification. Of 21 patients, only one patient with MALT has bulged tumor mass (>7 cm), other patients had tumor mass <5 cm. Six patients had core needle biopsy of tumor, 2 modified radical operation, and others tumor excision for diagnosis. All the patients received chemotherapy. The impacts of surgery, rituximab and prophylaxis with lumbar puncture on the outcomes of patients were analyzed. Survival was estimated using Kaplan-Meier method and compared by log-rank test. All the results were analyzed by SPSS 10.0.
Among 21 PBL patients, 19 achieved complete remission (CR), 1 partial remission (PR) and 1 disease progression (PD). Followed-up till July 2014, with median follow-up of 14 months (6-75 months), only one patient died, with 3-year survival of 92.3%. Compared with chemotherapy alone, the progression-free survival (PFS) of combination therapy (surgery plus chemotherapy) was significant longer (P=0.015), but without statistic differences of CR rate and overall survival (OS) between two groups. Among the 20 patients with CD20-positive tumor cells, 17 received Rituximab. PFS and OS, as well as CR rate of PBL had no difference between the treatment with and without Rituximab. The incidence of central nervous system (CNS) infiltration had no difference between patients with and without CNS prophylaxis through lumber-puncture and intrathecal injection.
With the common subtype of DLBCL, PBL patients had good outcome. Surgery, as a method to obtain tumor samples for diagnosis, could not prolong OS of patients. Therefore, radical operation shouldn't be recommended. PBL was reported to have high risk of CNS events, but prophylaxis with lumber puncture and intrathecal injection couldn't decrease the incidence of CNS infiltration.
分析原发性乳腺淋巴瘤（PBL）的临床特征、治疗方法及预后。
本研究纳入2003年1月至2013年12月在瑞金医院治疗的21例PBL患者，根据2008年世界卫生组织分类，其中弥漫性大B细胞淋巴瘤（DLBCL）17例、黏膜相关淋巴组织肿瘤（MALT）1例、滤泡性淋巴瘤（FL）1例、伯基特淋巴瘤1例、皮下脂膜炎样T细胞淋巴瘤1例。21例患者中，仅1例MALT患者肿瘤肿块隆起（>7 cm），其他患者肿瘤肿块<5 cm。6例患者行肿瘤粗针穿刺活检，2例行改良根治术，其余行肿瘤切除术以明确诊断。所有患者均接受化疗。分析手术、利妥昔单抗及腰椎穿刺预防对患者预后的影响。采用Kaplan-Meier法估计生存率，并通过对数秩检验进行比较。所有结果均采用SPSS 10.0软件进行分析。
21例PBL患者中，19例达到完全缓解（CR），1例部分缓解（PR），1例疾病进展（PD）。随访至2014年7月，中位随访时间为14个月（6 - 75个月），仅1例患者死亡，3年生存率为92.3%。与单纯化疗相比，联合治疗（手术加化疗）的无进展生存期（PFS）显著延长（P = 0.015），但两组的CR率和总生存期（OS）无统计学差异。20例肿瘤细胞CD20阳性的患者中，17例接受了利妥昔单抗治疗。接受利妥昔单抗治疗与未接受治疗的PBL患者的PFS、OS及CR率无差异。通过腰椎穿刺和鞘内注射进行中枢神经系统（CNS）预防的患者与未进行预防的患者CNS浸润发生率无差异。
PBL患者以常见的DLBCL亚型为主，预后良好。手术作为获取肿瘤样本以明确诊断的方法，不能延长患者的OS。因此，不建议行根治性手术。据报道，PBL发生CNS事件的风险较高，但腰椎穿刺和鞘内注射预防并不能降低CNS浸润的发生率。
