Clinicopathological characteristics and prognostic analysis of 92 cases with primary gastrointestinal diffuse large B-cell lymphoma

目的 探讨原发胃肠道弥漫大B细胞淋巴瘤(DLBCL)临床病理学特点、分子生物学标志与预后的相关性.方法 回顾性分析92例原发胃肠道DLBCL患者临床资料、病理及免疫组化特征,分析患者初诊时疾病状态与生存预后的关系.结果 92例患者中位年龄59(7～89)岁,男女比例1.56∶1,常见发病部位为胃(50.0％)、小肠(15.2％)、结肠(12.0％)、回盲部(10.9％)和多部位受累(9.8％).非生发中心型与生发中心型比例为2∶1.免疫组化染色示中位Ki-67阳性率＞80％,Bcl-2阳性率52.1％(48例中有25例).胃DLBCL患者幽门螺旋杆菌(Hp)阳性检出率为34.0％.随访的75例患者中位随访48(3～ 130)个月,化疗完全缓解率为66.7％,部分缓解率为22.7％,总有效率为89.4％,1、3、5年累积生存率分别为85.3％、66.2％和60.5％.多因素生存分析示原发结肠或胃肠多部位病变(RR=1.350,P=0.035)、诊断时合并低白蛋白血症(RR=2.723,P=0.026)为预后不良因素.联合利妥昔单抗化疗组(43例)较未联合化疗组(32例)完全缓解率提高(79.1％对46.9％,P=0.008),5年累积生存率明显改善(77.5％对53.1％,P=0.004).结论 原发胃肠道DLBCL是一组高侵袭性、高度异质性的恶性肿瘤.非生发中心型比例较高,原发结肠及胃肠多部位受累和诊断时合并低白蛋白血症是预后不良的因素.联合利妥昔单抗化疗可能有助于改善总体预后.To analyze the clinical and pathological features, molecular biological markers and prognosis of primary gastrointestinal diffuse large B-cell lymphoma (DLBCL).A retrospective study was conducted in 92 cases of primary gastrointestinal DLBCL. The data of clinical characteristics, pathological and immunohistochemical features were analyzed. The relationship between different factors at diagnosis and prognosis were studied.Of the 92 patients, the male-female ratio was 1.56:1 with a median age of 59(7-89) years. The most frequently involved site was stomach (50.0%), followed by small intestine (15.2%), colon (12.0%), ileocecum (10.9%) and multiple gastrointestinal tract involvements (9.8%). The ratio of non-germinal center B cell (non-GCB) subtype to germinal center B cell (GCB) was 2:1. Among the cases, Ki-67 had a high level expression with a median positive rate >80%. Positive expression of Bcl-2 was detected in 52.1% cases (25/48). Evidence of Helicobacter pylori (Hp) infections was detected in 34.0% cases with stomach involvement. Of the patients, 75 were included in a follow-up study with a median time of 48 months (3-130 months). The complete remission(CR)rate was 66.7%(50/75),the partial remission (PR) rate was 22.7% (17/75) and the overall response rate was 89.4% (67/75). The 1-, 3- and 5- year survival rates of the patients were 85.3%, 66.2% and 60.5%, respectively. The incidence of secondary malignancy after chemotherapy was 2.7%. The multivariate analysis indicated that primary colic DLBCL or multiple involvements of gastrointestinal tract and low serum albumin level (<35 g/L) at diagnosis were independently associated with poor outcome. Patients who received chemotherapy combined with rituximab (43 cases) had a higher CR rate (79.1% vs 46.9%, P=0.008) and 5-year overall survival (77.5% vs 53.1%, P=0.0045) than those without rituximab (32 case).Primary gastrointestinal DLBCL was a highly invasive and heterogeneous malignancy. In our data, the proportion of non-GCB subtype was higher. Primary colic DLBCL and those with multiple involvements of gastrointestinal tract had poor survival. Low serum albumin at diagnosis indicated poor outcome. Rituximab treatment in addition to chemotherapy might help to improve the clinical outcome. Further prospective trails were needed to confirm our results.首都健康培育项目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)04288-2943