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目的分析探讨原发胃肠道弥漫性大B细胞淋巴瘤(PGI-DLBcL)临床治疗方法的合理选择。方法收集1998-2010年上海仁济医院收治的PGI-DLBCL 124例。剔除因并发症急诊手术治疗及随访资料不全病例,以年龄和Ann Arbor分期为配对因素,按l:1:1比例选择单纯手术、单纯化疗和手术联合化疗病例各23例进行病例对照研究。通过免疫组化检测CDl0、BCL一6和MUMl表达,并进行免疫表型分型。回顾性分析69例PGI-DLBCL病人的临床资料、免疫表型分型、治疗方法及预后,并进行统计学分析。结果 69例病人免疫表型分型:30.4%(21/69)为生发中心B细胞(GCB)型,69.6%(48,69)为非GCB型。69例病人2年、3年和5年总体存活率(0S)分别为69.5%、58.7%和42.4%。Ann Arbor临床分期I_E、Ⅱ_E期病人平均OS(61.5±5.9)个月长于Ⅲ_E、Ⅳ_E期病人[(32.3±6.2)个月],差异有统计学意义(P<0.05)。GCB型病人平均OS(73.9±8.3)个月长于非GcB型病人[(48.1±5.8)个月]。差异有统计学意义(P<0.05)。单纯手术组、单纯化疗组和手术联合化疗组在年龄、性别、发病部位、Ann Arbor分期、有无B症状和免疫表型分型方面无显著性差异。单纯化疗组和手术联合化疗组中利妥昔单联合cHOP化疗(R-CHOP)与传统CHOP化疗病人比例差异无统计学意义。生存分析显示:手术联合化疗组平均0S(73.9±7.8)个月长于单纯手术组[(37.5±5.8)个月]和单纯化疗组[(34.8±6.4)个月]。差异有统计学意义(P<0.05)。结论 Ann Arbor临床分期和免疫表型分型对PGI-DLBcL预后判断具有重要意义,手术联合术后化疗是PGI-DLBCL合理的治疗方法 。
Objective To analyze and discuss the rational choice of clinical treatment of primary gastrointestinal diffuse large B cell lymphoma (PGI-DLBcL). Methods 124 cases of PGI-DLBCL in Renji Hospital of Shanghai from 1998 to 2010 were collected. Excluding the complications of emergency surgery and follow-up data cases, with age and Ann Arbor staging as a matching factor, select l: 1: 1 ratio of simple surgery, chemotherapy and surgery combined with chemotherapy in 23 cases of each case-control study. The expressions of CD10, BCL-6 and MUM1 were detected by immunohistochemistry and immunophenotyping was performed. The clinical data, immunophenotyping, treatment and prognosis of 69 patients with PGI-DLBCL were retrospectively analyzed and statistically analyzed. Results The immunophenotyping of 69 patients was found in 30.4% (21/69) of germinal center B cells (GCB) and 69.6% (48.69) of non-GCB. The overall survival rates (OS) of 69 patients at 2, 3 and 5 years were 69.5%, 58.7% and 42.4%, respectively. Ann Arbor clinical stage I_E, Ⅱ_E patients with OS (61.5 ± 5.9) months longer than Ⅲ_E, Ⅳ_E patients [(32.3 ± 6.2) months], the difference was statistically significant (P <0.05). The average OS of GCB patients (73.9 ± 8.3) months was longer than that of non-GcB patients (48.1 ± 5.8 months). The difference was statistically significant (P <0.05). There were no significant differences in age, gender, location of disease, Ann Arbor staging, presence or absence of B symptoms and immunophenotyping in the simple operation group, simple chemotherapy group and operation combined with chemotherapy group. There was no significant difference in the proportions of RCHO chemotherapy and conventional CHOP chemotherapy between the chemotherapy alone group and the surgery combined with chemotherapy group. Survival analysis showed that the average duration of surgery in combination with chemotherapy was 0S (73.9 ± 7.8) months longer than that of the surgery alone group (37.5 ± 5.8 months) and the chemotherapy alone group (34.8 ± 6.4 months). The difference was statistically significant (P <0.05). Conclusion Ann Arbor clinical stage and immunophenotyping are of great significance for the prognosis of PGI-DLBcL. Surgery combined with postoperative chemotherapy is a reasonable treatment for PGI-DLBCL.