侵袭性原发性肠道 B 细胞和 T/NK 细胞淋巴瘤的临床病理特征和治疗结局比较。

Comparison of clinicopathological features and treatment outcomes in aggressive primary intestinal B- and T/NK-cell lymphomas.

机构信息

Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan.

出版信息

J Formos Med Assoc. 2021 Jan;120(1 Pt 2):293-302. doi: 10.1016/j.jfma.2020.10.001. Epub 2020 Oct 21.

DOI:10.1016/j.jfma.2020.10.001

PMID:33289640

Abstract

BACKGROUND

Primary intestinal lymphomas (PILs) are rare, and this study compared the clinical outcomes of aggressive primary intestinal B-cell lymphomas (aB-PILs) and T/natural killer-cell lymphomas (T/NK-PILs).

METHODS

The clinical information of patients diagnosed with aggressive PILs at our institution between 1995 and 2015 were retrospectively investigated. Pathological subtypes were confirmed according to the 2016 revision of the World Health Organization classification. The correlation between clinicopathological features and overall survival (OS) was determined using univariate and multivariate analyses.

RESULTS

Cases of T/NK-PILs had higher initial bowel perforation incidence (67% vs. 7%, P < 0.001) and lower complete response rate to first-line chemotherapy regimens (22% vs. 69%, P = 0.009) than aB-PILs. Patients with aB-PILs had a better 5-year event-free survival rate (55.8% vs. 13.9%, P = 0.026) and a 5-year OS rate (74.3% vs. 29.6%, P = 0.036) than those with T/NK-cell lymphomas. Multivariate analysis identified that female gender and stage III/IV were unfavorable prognostic factors. Among the 54 patients with diffuse large B-cell lymphoma (DLBCL), those with International Prognostic Index (IPI) scores of 0-2 had a better 5-year OS rate than those with scores of 3-5 (84.2% vs. 46.8%, P = 0.002). IPI scores of 3-5 (P = 0.026) and tumors located in the large intestine (P = 0.015) were poor prognostic factors based on the multivariate analysis.

CONCLUSION

The prognosis of T/NK-PILs was less favorable than that of aB-PILs. Female gender, stage III/IV disease, DLBCL with IPI scores of 3-5, or tumors in the large intestine were poor prognostic factors.

摘要

背景

原发性肠道淋巴瘤（PILs）较为罕见，本研究比较了侵袭性原发性肠道 B 细胞淋巴瘤（aB-PILs）和 T/NK 细胞淋巴瘤（T/NK-PILs）的临床结局。

方法

回顾性调查了 1995 年至 2015 年期间我院诊断为侵袭性 PILs 的患者的临床资料。根据 2016 年世界卫生组织分类修订版确认病理亚型。采用单因素和多因素分析确定临床病理特征与总生存（OS）的相关性。

结果

T/NK-PIL 组初始肠穿孔发生率（67% vs. 7%，P < 0.001）和一线化疗方案完全缓解率（22% vs. 69%，P = 0.009）均高于 aB-PIL 组。aB-PIL 组患者 5 年无事件生存率（55.8% vs. 13.9%，P = 0.026）和 5 年 OS 率（74.3% vs. 29.6%，P = 0.036）均优于 T/NK 细胞淋巴瘤组。多因素分析发现，女性和 III/IV 期是不利的预后因素。在 54 例弥漫性大 B 细胞淋巴瘤（DLBCL）患者中，国际预后指数（IPI）评分 0-2 分的患者 5 年 OS 率优于 3-5 分的患者（84.2% vs. 46.8%，P = 0.002）。基于多因素分析，IPI 评分 3-5 分（P = 0.026）和肿瘤位于大肠（P = 0.015）是不良预后因素。