He Y, Wang L, Zhu H Y, Liang J H, Wu W, Wu J Z, Xia Y, Cao L, Fan L, Li J Y, Xu W
Department of Hematology, Nanjing Medical University First Affiliated Hospital, Jiangsu Provincial People Hospital, Nanjing 210029, China.
Zhonghua Xue Ye Xue Za Zhi. 2017 Jun 14;38(6):505-510. doi: 10.3760/cma.j.issn.0253-2727.2017.06.008.
To analyze the clinical characteristics, treatment and prognosis of primary gastric lymphomas (PGL). A retrospective study was conducted in 124 cases of PGL from July 2009 to January 2016 in our hospital, and the clinical records, pathological and immunohistochemical features were analyzed. The relationship between different factors at diagnosis and prognosis were studied. 124 cases of PGL included 93 diffuse large B cell lymphoma (DLBCL) patients, 25 mucosa associated lymphoid tissue (MALT) lymphoma cases, 1 mantle cell lymphoma, 4 peripheral T-cell lymphoma-not otherwise specified, and 1 extra-nodal NK/T-cell lymphoma-nasal type. Of the 93 primary gastric DLBCL (PG-DLBCL) patients, the germinal center B cell-like (GCB) DLBCL were 45 cases, non-GCB DLBCL were 48 cases. 10 cases (10.8%) of 93 PG-DLBCL were transformed from gastric MALT, and 7 cases (7.5%) have bone marrow involvement. Evidence of Helicobacter pylori infection was detected in 21 cases (51.2%) of 41 DLBCL patients and in 10 cases (43.5%) of 23 MALT patients. Univariate analysis revealed that clinical stages (=0.002) , B symptoms (=0.001) , international prognostic index (IPI) score (<0.001) , anemia (<0.001) , low level of serum albumin level (=0.001) , high level of lactate dehydrogenase (LDH) (<0.001) , high β2-microglobulin (=0.003) , chemotherapy uncombined with rituximab (=0.006) were factors affecting progression-free survival (PFS). Multivariate Cox regression analysis indicated that clinical stages (=5.113, 95% 1.087-24.048, =0.039) and LDH (=5.111, 95% 1.651-15.827, =0.005) were independent poor prognosis factors affecting PFS. In the non-GCB group, the PFS was significantly extended (=0.013) , the OS has no statistical significance (=0.764). The PFS was significantly shortened in MALT transformed to DLBCL compared with MALT lymphoma patients (=0.016) , but have no statistical significance compared with DLBCL patients (=0.373). The types of DLBCL and MALT are more common in PGL. PG-DLBCL is a highly heterogeneous malignant tumor, and advanced clinical stages and high LDH value are associated with poor outcome.
分析原发性胃淋巴瘤（PGL）的临床特征、治疗及预后。对2009年7月至2016年1月我院收治的124例PGL患者进行回顾性研究，分析其临床记录、病理及免疫组化特征。研究诊断时不同因素与预后的关系。124例PGL患者中，包括93例弥漫性大B细胞淋巴瘤（DLBCL）患者、25例黏膜相关淋巴组织（MALT）淋巴瘤患者、1例套细胞淋巴瘤、4例未另行特指的外周T细胞淋巴瘤及1例鼻型结外NK/T细胞淋巴瘤。93例原发性胃DLBCL（PG-DLBCL）患者中，生发中心B细胞样（GCB）DLBCL 45例，非GCB DLBCL 48例。93例PG-DLBCL患者中10例（10.8%）由胃MALT转化而来，7例（7.5%）有骨髓受累。41例DLBCL患者中21例（51.2%）及23例MALT患者中10例（43.5%）检测到幽门螺杆菌感染证据。单因素分析显示，临床分期（=0.002）、B症状（=0.001）、国际预后指数（IPI）评分（<0.001）、贫血（<0.001）、血清白蛋白水平低（=0.001）、乳酸脱氢酶（LDH）水平高（<0.001）、β2-微球蛋白高（=0.003）、未联合利妥昔单抗化疗（=0.006）是影响无进展生存期（PFS）的因素。多因素Cox回归分析表明，临床分期（=5.113，95% 1.087 - 24.048，=0.039）和LDH（=5.111，95% 1.651 - 15.827，=0.005）是影响PFS的独立不良预后因素。在非GCB组中，PFS显著延长（=0.013），总生存期无统计学意义（=0.764）。与MALT淋巴瘤患者相比，MALT转化为DLBCL时PFS显著缩短（=0.016），但与DLBCL患者相比无统计学意义（=0.373）。DLBCL和MALT类型在PGL中更为常见。PG-DLBCL是一种高度异质性恶性肿瘤，临床晚期和高LDH值与不良预后相关。
