Primary testicular non-Hodgkin's lymphoma: clinical analysis of 21 cases

目的 研究原发睾丸非霍奇金淋巴瘤(NHL)的临床特征及预后因素.方法 回顾性分析2005年1月至2012年12月在北京大学肿瘤医院住院治疗的初治21例原发睾丸NHL患者的临床资料,总结其临床特征并分析其预后因素.结果 21例患者年龄34～86岁,中位年龄59岁.其中Ⅰ期患者8例,Ⅱ期患者2例,Ⅳ期患者11例；4例患者合并B症状；12例患者出现睾丸以外的结外部位受侵；起病时乳酸脱氢酶(LDH)升高者6例；国际预后指数(IPI)评分0～1分(低危组)10例,3分(中高危组)10例,4分(高危组)1例.15例患者诊断时行手术切除；7例患者在化疗结束后行局部放疗；15例患者在治疗过程中接受预防性鞘内注射.全组病理诊断均为弥漫大B细胞淋巴瘤(DLBCL),其中11例为非生发中心来源.一线治疗采用R-CHOP(利妥昔单抗、环磷酰胺、阿霉素、长春新碱、泼尼松)或CHOP类方案化疗,获完全缓解率为85.7％.随访6～58个月,中位随访时间18个月.患者1、2、3年生存率分别为100％、80％和60％.Log-Rank检验显示一线化疗方案是否含有利妥昔单抗为独立预后因素(P=0.038),而分期(P =0.275)、起病时LDH(P=0.179)以及β2-微球蛋白(β2-MG) (P =0.229)是否升高、IPI(P =0.275)这4项因素虽有对生存产生影响的趋势,但差异无统计学意义.结论 原发睾丸NHL预后通常较差,一线化疗方案是否含有利妥昔单抗为患者预后因素.To explore the clinical characteristics and prognosis of patients with primary testicular non-Hodgkin's lymphoma.The clinical profiles and prognostic factors of 21 cases newly diagnosed as primary testicular non-Hodgkin's lymphoma at Peking University Cancer Hospital from January 2005 to December 2012 were retrospectively analyzed.Their median age was 59 (34-86) years. And they were classified as Ann Arbor stage I (n = 8), stage II (n = 2) and stage IV (n = 11). There were B symptoms (n = 4), extranodal involvement outside testis (n = 12) and elevated lactate dehydrogenase (LDH) at diagnosis (n = 6). The scores of international prognostic index (IPI) were 0-1 point (n = 10), 3 points (n = 10) and 4 points (n = 1). The regimens included orchidectomy as the initial treatment (n = 15), chemotherapy followed by radiotherapy (n = 7) and CNS prophylaxis during treatment (n = 15). All patients were pathologically diagnosed as diffuse large B-cell lymphoma. And 11 cases belonged to the non-germinal center B cell-like subgroup.First-line chemotherapy was either R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) or CHOP-like-based regimen. Complete response was achieved in 85.7% of patients. The median follow-up period was 18 (6-58) months. The 1, 2 and 3-year survival rates were 100%, 80% and 60% respectively. Statistical analysis showed that the first-line chemotherapy with rituximab was a prognostic factor (P = 0.038).Other factors included stage (P = 0.275), LDH level (P = 0.179) , β2-microglobulin level (P = 0.229) and IPI (P = 0.275) .The prognosis of primary testicular non-Hodgkin's lymphoma is usually poor. The first-line chemotherapy with rituximab is a prognostic factor.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)0282209-22119