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目的原发小肠非霍奇金淋巴瘤(primary small intestinal non-Hodgkin’s lymphoma,PSI-NHL)发病率极低,国内外相关数据较为缺乏。本研究旨在探讨PSI-NHL的临床病理特征、治疗方法及预后因素。方法回顾性分析2007-01-01-2014-01-01天津医科大学肿瘤医院收治的67例PSI-NHL患者的临床资料,采用Kaplan-Meier法计算总生存(overall survival,OS)率,行Log-rank检验单因素分析和Cox比例风险模型多因素分析。结果 67例患者中男41例,女26例,男女比例为1.58∶1,中位年龄55(7~79)岁。病变原发于回肠40例(包括回盲部23例),十二指肠14例,空肠13例。B细胞淋巴瘤55例(82.1%),T细胞淋巴瘤12例(17.9%)。ECOG评分<2 55例(82.1%)。根据Lugano分期,早期(Ⅰ~Ⅱ2期)32例(47.8%)。根据国际预后指数(international prognostic index,IPI)评分分组,低危组35例(52.2%),中危组22例(32.8%),高危组10例(14.9%)。67例患者的1、3和5年OS率分别为77.3%、60.5%和50.6%。单因素分析显示,病理类型、肿块大小、Lugano分期、IPI评分、乳酸脱氢酶(lactate dehydrogenase,LDH)水平、低白蛋白血症及治疗方法对预后有影响,均P值<0.05。多因素分析显示,IPI(P=0.045,95%CI为1.01~4.03)、低蛋白血症(P=0.033,95%CI为1.09~7.35)和治疗方法(P=0.019,95%CI为0.30~0.90)为独立预后因素。各治疗组中,手术联合化疗组的预后最好。结论 PSI-NHL发病率低,起病隐匿且临床表现无特异性,以B细胞表型为主,预后显著优于T细胞淋巴瘤。IPI评分、低蛋白血症及治疗方法为影响PSI-NHL生存的独立预后因素。手术联合化疗可作为PSI-NHL的最佳治疗策略。
Objective The incidence of primary small intestinal non-Hodgkin’s lymphoma (PSI-NHL) is extremely low, and there is a lack of relevant data at home and abroad. The purpose of this study was to investigate the clinicopathological characteristics, treatment and prognostic factors of PSI-NHL. Methods The clinical data of 67 patients with PSI-NHL admitted to Tumor Hospital of Tianjin Medical University from January 2007 to January 2014 were analyzed retrospectively. The Kaplan-Meier method was used to calculate the overall survival (OS) -rank test univariate analysis and Cox proportional hazards model multivariate analysis. Results There were 41 males and 26 females in 67 patients, with a male-female ratio of 1.58:1. The median age was 55 (range, 7 to 79) years. Lesions in the ileum in 40 cases (including ileocecal 23 cases), 14 cases of duodenum, jejunum in 13 cases. 55 cases of B cell lymphoma (82.1%), T cell lymphoma in 12 cases (17.9%). ECOG score <2 55 cases (82.1%). According to Lugano staging, 32 cases (47.8%) were early stage Ⅰ ~ Ⅱ2. According to the international prognostic index (IPI) score, there were 35 cases (52.2%) in low risk group, 22 cases (32.8%) in intermediate risk group and 10 cases (14.9%) in high risk group. The 1, 3, and 5-year OS rates for the 67 patients were 77.3%, 60.5%, and 50.6%, respectively. Univariate analysis showed that pathological type, mass size, Lugano staging, IPI score, lactate dehydrogenase (LDH) level, hypoalbuminemia and treatment had an impact on prognosis, all P <0.05. In the multivariate analysis, there was no significant difference between IPI (P = 0.045, 95% CI 1.01 ~ 4.03), hypoproteinemia (P = 0.033,95% CI 1.09 ~ 7.35) and treatment (P = 0.019,95% CI 0.30 ~ 0.90) as independent prognostic factors. In each treatment group, the surgery combined with chemotherapy group had the best prognosis. Conclusions The incidence of PSI-NHL is low, occult onset and clinical manifestations are nonspecific. The predominance of PSI-NHL is predominantly B-cell phenotype with significantly better prognosis than T-cell lymphoma. IPI score, hypoproteinemia and treatment of PSI-NHL affect the survival of independent prognostic factors. Surgery combined with chemotherapy can be used as PSI-NHL the best treatment strategy.