Hai Tao, Zou Li-Qun
Cancer Center, West China Hospital, Chengdu 610041, Sichuan Province, China.
Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Clin Cases. 2021 Nov 6;9(31):9417-9430. doi: 10.12998/wjcc.v9.i31.9417.
The liver as a primary site of lymphoma is rarely seen, they are usually misdiagnosed as hepatocellular carcinoma, . In 2017, a review of primary hepatic lymphoma (PHL) was done in immunocompetent diffuse large B-cell lymphoma (DLBCL) patients. Yet questions that include treatment choosing or susceptibility of immunoincompetent patients remain disputable.
To investigate the clinical characteristics of patients with PHL.
We collected PHL cases on PubMed, and extracted demographic and clinicopathological data to perform a systematic analysis. Survival analysis regarding age, lactate dehydrogenase (LDH), liver function abnormality (LFA), and treatment modalities were conducted. The Kaplan-Meier method and Cox regression were used to identify risk factors.
Of 116 PHL patients with DLBCL (62.1%) as the most common subtype. Biopsy methods before surgery produced a 97% positive rate. Progression-free survival (PFS) was significantly shortened in patients with elevated LDH [Hazard ratio (HR): 3.076, 95% confidence interval (CI): 1.207-7.840, = 0.018] or LFA (HR: 2.909, 95%CI: 1.135-7.452, = 0.026). Univariate Cox regression analysis suggesting that LDH, liver function, B symptom, hepatosplenomegaly, and lesion were significantly associated with PHL patients survival ( < 0.05). Heavy disease burden was observed in deceased patients. A few PHL patients (3.4%) have slightly higher tumor markers.
PHL patients with elevated LDH and LFA tend to have shorter PFS. Biopsy before treatment in undecided patients with no tumor markers exceeds upper limits has the most essential clinical significance, especially in immunoincompetent patients.
肝脏作为淋巴瘤的主要发病部位较为少见，通常易被误诊为肝细胞癌。2017年，对免疫功能正常的弥漫性大B细胞淋巴瘤（DLBCL）患者的原发性肝淋巴瘤（PHL）进行了综述。然而，包括免疫功能不全患者的治疗选择或易感性等问题仍存在争议。
探讨PHL患者的临床特征。
我们在PubMed上收集PHL病例，并提取人口统计学和临床病理数据进行系统分析。对年龄、乳酸脱氢酶（LDH）、肝功能异常（LFA）和治疗方式进行生存分析。采用Kaplan-Meier法和Cox回归分析确定危险因素。
116例PHL患者中，DLBCL为最常见亚型（62.1%）。术前活检方法的阳性率为97%。LDH升高（风险比[HR]：3.076，95%置信区间[CI]：1.207 - 7.840，P = 0.018）或LFA升高（HR：2.909，95%CI：1.135 - 7.452，P = 0.026）的患者无进展生存期（PFS）显著缩短。单因素Cox回归分析表明，LDH、肝功能、B症状、肝脾肿大和病灶与PHL患者的生存显著相关（P < 0.05）。死亡患者观察到疾病负担较重。少数PHL患者（3.4%）肿瘤标志物略高。
LDH和LFA升高的PHL患者PFS往往较短。对于肿瘤标志物未超过上限的未确诊患者，治疗前活检具有最重要的临床意义，尤其是在免疫功能不全的患者中。
