Long term follow-up and prognostic analysis of 85 cases with primary gastrointestinal diffuse large B cell lymphoma

目的 探讨影响原发胃肠道弥漫大B细胞淋巴瘤(PGI-DLBCL)患者预后生存的相关因素.方法 通过长期随访和收集85例PGI-DLBCL患者资料,分析患者的临床特征、治疗方案与其预后生存的相关性.结果 85例患者中男55例,女30例,男、女比例为1.83:1,中位发病年龄61 (18～87)岁.胃部发病63.5％ (54/85),肠道发病35.3％(30/85),胃肠道多部位发病1.2％ (1/85).骨髓侵犯16.4％ (11/64),幽门螺杆菌感染阳性率51.4％(19/37).全部患者5年总生存率为63.9％.胃部、肠道组患者5年总生存率分别为75.3％、44.1％,差异有统计学意义(P=0.005).生发中心来源(GCB)、非GCB组患者5年总生存率分别为64.7％、62.4％,差异无统计学意义(P=0.610).单因素分析显示影响患者总生存的因素包括年龄、病变部位、病变大小、胃肠道淋巴瘤Lugano分期、IPI评分(P值均＜0,05).多因素分析显示影响患者总生存的独立危险因素为IPI评分(RR=3.609,95 CI 2.034～6.404,P＜0.01).结论 IPI评分是影响PGI-DLBCL患者总生存的独立危险因素.To analyze the clinical characteristics, prognostic factors in patients with primary gastrointestinal diffuse large B cell lymphoma (PGI-DLBCL).Long term follow-up of 85 patients with PGI-DLBCL was carried out and the patients clinical data were retrospectively evaluated. The risk factors for survival rate were analyzed by univariate and multivariate Cox regression analysis.The median age of 85 patients was 61 years old (18-87), and male: female ratio was 1.83:1 (55/30). The stomach origin accounted for 63.5% (54/85), intestine origin for 35.3% (30/85) and multiple GI involvements for 1.2% (1/85). Bone marrow involvement accounted for 16.4% (11/64), Helicobacter pylori (HP) infection for 51.4% (19/37). The 5-year overall survival (OS) rates of all patients were 63.9%. The 5-year OS of patients in stomach and intestinal groups were 75.3% and 44.1%, respectively (P=0.005). The 5-year OS of germinal center B cell-like (GCB) group and non-GCB groups were 64.7% and 62.4%, respectively (P = 0.610). Univariated analysis revealed that the factors affecting OS of patients included age, lesion site, tumor size, gastrointestinal clinical Lugano staging system, IPI score (all P values < 0.05). Multivariate Cox regression analysis revealed that IPI score was independent prognosis risk factor affecting OS (RR = 3.609, 95 CI 2.034-6.404, P < 0.01).IPI score was independent prognosis risk factor affecting OS of PGI-DLBCL patients.国家自然科学基金; 卫生公益性行业科研专项PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)010909-9133