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目的:探究孤立性浆细胞瘤患者的临床特点、治疗方法及预后相关因素。方法:搜集2000年6月至2012年10月就诊于天津医科大学肿瘤医院的644例恶性浆细胞肿瘤患者的临床资料,并对其临床特点、治疗方案、预后因素等进行分析,其中孤立性浆细胞瘤(solitary plasmacytoma,SP)患者有66例占10.25%。结果:根据SP的发生部位可分为骨孤立性浆细胞瘤(solitary bone plasmacytoma,SBP)和髓外浆细胞瘤(extramedullary plasmacytoma,EMP)。SBP大部分发生在椎体,而髓外浆细胞瘤好发于上呼吸道。此外,两者在肿块大小、血清M蛋白水平、尿本周氏蛋白水平以及是否更易进展为多发性骨髓瘤(multiple myeloma,MM)等方面的差异均具有统计学意义(P<0.05)。多因素分析结果表明,SBP患者的肿块越大(d≥5 cm),其肿瘤的局部控制率(local control,LC)、无骨髓瘤进展生存期(multiple myeloma-free survival,MMFS)、总生存期(overall survival,OS)及无病进展生存期(progressionfree survival,PFS)越差;对于EMP患者来说,放疗以及血清β2-微球蛋白<3.5 mg/L是预后良好的因素。结论:肿块大小、血清M蛋白、尿本周氏蛋白、血清β2-微球蛋白水平可为临床判断SBP与EMP预后及指导治疗提供帮助。
Objective: To investigate the clinical features, treatment and prognosis of patients with solitary plasmacytoma. Methods: The clinical data of 644 patients with malignant plasma cell tumor who were treated in Cancer Hospital of Tianjin Medical University from June 2000 to October 2012 were collected. The clinical features, treatment plans and prognostic factors were analyzed. Among them, solitary pulp 66 cases of solitary plasmacytoma (SP) accounted for 10.25%. Results: According to the location of SP, it could be divided into solitary bone plasmacytoma (SBP) and extramedullary plasmacytoma (EMP). The majority of SBP occurs in the vertebral body, whereas extramedullary plasmacytomas predispose the upper respiratory tract. In addition, the differences were statistically significant (P <0.05) in terms of tumor size, serum M protein level, urine ZHOU protein level, and whether it was more likely to progress to multiple myeloma (MM). Multivariate analysis showed that the larger the mass of the SBP patients (d≥5 cm), the local control (LC), multiple myeloma-free survival (MMFS), overall survival Overall survival (OS) and progressionfree survival (PFS) were worse; for EMP patients, radiotherapy and serum β2-microglobulin <3.5 mg / L were prognostic factors. Conclusions: The size of the tumor, serum M protein, urine benign protein and serum β2-microglobulin levels may be helpful in predicting the prognosis and guiding the treatment of SBP and EMP clinically.