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目的 :探讨原发性扁桃体局限期弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)的临床病理特征和预后。方法 :回顾性分析2008年1月—2014年1月在北京大学肿瘤医院确诊为原发性扁桃体局限期DLBCL并接受利妥昔单抗联合化疗治疗的33例患者的临床病理资料,并进行随访。结果 :33例患者的中位年龄为45岁(范围:15~88岁);非生发中心B细胞样(non-germinal center B-cell-like,non-GCB)来源患者26例(78.8%);其中,9例患者还接受了巩固放疗。利妥昔单抗联合化疗治疗后,30例(90.9%)获得完全缓解,2例(6.1%)获得部分缓解,总有效率为97.0%(32/33)。中位随访时间为40个月(范围:9~84个月)。33例患者的估计5年生存率为97%。预后的单因素分析结果显示,只有近期疗效与预后相关(P=0.000),而年龄、性别、Ann Arbor分期、血清乳酸脱氢酶水平、国际预后指数、免疫表型和放疗均与预后无显著相关性(P>0.05)。预后的多因素分析结果显示,近期疗效不是独立的预后因素(P>0.05)。结论:原发性扁桃体局限期DLBCL的病理分型以non-GCB为主,在给予6个周期利妥昔单抗联合化疗治疗后,无论是否联合放疗,均可取得很好的疗效。今后仍需开展前瞻性的大样本研究以进一步验证是否需要进行巩固放疗。
Objective: To investigate the clinicopathological characteristics and prognosis of diffuse large B-cell lymphoma (DLBCL) in primary tonsil. Methods: The clinical and pathological data of 33 patients who were diagnosed as DLBCL with primary tonsil and received combined chemotherapy with rituximab at Peking University Cancer Hospital from January 2008 to January 2014 were retrospectively analyzed and followed up . Results: The median age of 33 patients was 45 years (range: 15-88 years). Twenty-six patients (78.8%) were non-germinal center B-cell-like (non-GCB) Among them, 9 patients also received consolidation radiotherapy. Rituximab combined with chemotherapy, 30 patients (90.9%) were completely relieved, 2 patients (6.1%) were partially relieved, the total effective rate was 97.0% (32/33). The median follow-up time was 40 months (range: 9-84 months). The estimated 5-year survival rate for the 33 patients was 97%. The univariate analysis of prognosis showed that only the short-term efficacy was related to the prognosis (P = 0.000). However, age, sex, Ann Arbor stage, serum lactate dehydrogenase level, international prognostic index, immunophenotype and radiotherapy were not significantly different from the prognosis Correlation (P> 0.05). Multivariate analysis of prognosis showed that the short-term efficacy was not an independent prognostic factor (P> 0.05). CONCLUSION: The pathologic type of DLBCL in primary tonsil degeneration is mainly non-GCB. After 6 cycles of rituximab combined with chemotherapy, whether with or without radiotherapy, good curative effect can be obtained. Future prospective large-scale study is still needed to further verify the need for consolidation of radiotherapy.