Analysis of prognostic factors of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue

目的 分析黏膜相关淋巴组织结外边缘区B细胞淋巴瘤(MALT淋巴瘤)的临床病理学特点,并探讨其预后相关指标.方法 选取86例MALT淋巴瘤患者,依据肿瘤发生部位分为胃MALT淋巴瘤组(32例)和非胃MALT淋巴瘤组(54例).常规HE染色、免疫组织化学(EnVision二步法)观察其病理学特点,采用间期荧光原位杂交( FISH)方法对部分病例检测肿瘤特征性的分子遗传学改变,并对病例进行临床随访.结果 两组病例临床病理学特点无明显差异.间期FISH检测结果显示t(11;18)和t(14;18)发生率分别为12％(6/50)和9％(4/45).胃MALT淋巴瘤组中20例获得随访,均接受单纯抗幽门螺杆菌治疗,bcl-10核表达阳性、存在t(11;18)病例的缓解率(20％、33％)显著低于阴性组(73％、91％),差异均有统计学意义( x2=3.842,P=0.035;x2=4.639,P=0.031).非胃MALT淋巴瘤组病例中35例获得随访,女性、年龄≤60岁患者的缓解率(60％、63％)显著高于男性、＞ 60岁患者(35％、25％),差异均有统计学意义(x 2=3.905,P=0.048;x2=7.373,P=0.007);临床Ⅰ～Ⅱ期、t(14;18)患者的无进展生存(PFS)率(52％、75％)显著高于Ⅲ～Ⅳ期、t(14;18)阴性者(25％、50％),差异均有统计学意义(x 2=4.207,P=0.040; x2=4.363,P=0.037).结论 MALT淋巴瘤是一类好发于中老年人的惰性淋巴瘤,预后较好,胃与非胃MALT淋巴瘤存在不同的治疗反应评估或预后预测指标.Objective To study the clinicopathologic features and explore the potential prognostic factors of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma).Methods 86 patients diagnosed with MALT lymphoma were retrieved and divided into 2 subgroups according to the location of tumor,namely gastric (32 cases) and non-gastric (54 cases) subgroup.Histological characteristics were reassessed on hematoxylin-eosin staining slides,and immunophenotypic features were determined by immunohistochemical staining.Interphase fluorescence in-situ hybridization (FISH) was carried out to detect the cytogenetic abnormalities.Results There were no significant difference of clinical behavior,histology,and immunophenotype between gastric and non-gastric subgroups.In addition,FISH detected t(14;18) in 9 ％ (4/45) and t(11;18) in 12 ％ cases (6/50) respectively.Among the 20 cases treated with H pylori (HP) eradication,a significantly lower remission rate was observed in cases with bcl-10 (20 ％) nuclear expression or those harboring t(11;18) (33 ％) compared with those in the negative group (73 ％,91％)(x2 =3.842 and 4.639,P =0.035 and 0.031,respectively).For the 35 non-gastric patients with follow-up data,males (35 ％) and patients older than 60 yrs (25 ％) tended to have a lower remission rate as compared to females (60 ％) and those younger than 60 yrs (63 ％) (x2 =3.905 and 7.373,P =0.048 and 0.007,respectively).Moreover,progression-free survival rate was significantly lower in patients with higher stage (ⅢⅣ) (25 ％) and without t(14;18) (50 ％) than that in patients with stage Ⅰ-Ⅱ (52 ％) and with t(14;18)(75 ％).The differences had statistical significance (x2 =4.207 and 4.363,P =0.040 and 0.037,respectively).Conclusion MALT lymphoma in general is an indolent B-cell non-Hodgkin’ s lymphoma which more frequently occurs in the elderly people.Differences in the response to treatment or the prognosis are observed between gastric and non-gastric MALT lymphoma patients.北京市自然科学基金08456-4602