论文部分内容阅读
目的:分析儿童青少年霍奇金淋巴瘤(HL)患者的病理特征、临床表现及其预后影响因素。方法:收集青岛大学医学院附属医院血液儿科2001年5年至2013年8月收治的23例经病理确诊的儿童青少年HL患者的临床资料,采用Fisher确切概率法等进行各组间差异检验。结果:确诊病例共23例,中位年龄7.5岁,男:女发病比例=6.7:1,Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期分别占13.0%、26.2%、30.4%、30.4%;结节性淋巴细胞为主型(NLPHL)1例(4.3%),经典型HL22例(95.7%):混合细胞型(MC)10例(43.5%),淋巴细胞为主型(LP)11例(47.9%),结节硬化型(NS)1例(4.3%);受累部位以颈部淋巴结最多见,其次依次为纵隔、腹腔及腹膜后、脾、骨骼、肺组织等,其中巨大纵隔肿块者2例;具有B症状者8例(34.7%)。化疗2个疗程评估总有效率为100%,完全缓解(CR)率69.6%,部分缓解(PR)率30.4%。Ⅰ期和Ⅱ期患者CR率100%,明显高于Ⅲ期和Ⅳ期患者(50%),P<0.05;23例患者7例复发,复发率Ⅲ期和Ⅳ期患者为46.2%,Ⅰ期和Ⅱ期患者为11.1%,前者高于后者(P=0.0098);有B症状与无B症状患者之间复发率有显著统计学差异(P=0.019);2例有巨大包块患者皆复发;各病理分型与疾病的复发间差异无统计学意义(x2=2.695,P>0.05)。结论:儿童霍奇金淋巴瘤预后相对较好,但Ⅲ期和Ⅳ期、合并B症状及大肿块或大纵隔肿瘤的患者复发率高,应依据疾病危险度分层治疗,以期更好的预后。
Objective: To analyze the pathological features, clinical manifestations and prognostic factors of Hodgkin lymphoma (HL) in children and adolescents. Methods: The clinical data of 23 patients with pathologically diagnosed HL in children and adolescents admitted to Department of Hematology and Pediatrics, Affiliated Hospital of Qingdao University Medical College from 2001 to August 2013 were collected. Fisher exact test was used to test the differences between groups. Results: A total of 23 confirmed cases were diagnosed with a median age of 7.5 years. The incidence rate of male to female was 6.7: 1. The incidence rates of stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 13.0%, 26.2%, 30.4% and 30.4% respectively. (NLPHL) was 1 (4.3%), classic HL22 cases (95.7%) were mixed cell type (MC) in 10 cases (43.5%) and lymphocyte predominance (LP) in 11 cases 47.9%), and 1 (4.3%) with nodular sclerosis (NS). The most common sites were cervical lymph nodes, followed by mediastinum, abdominal cavity and retroperitoneum, spleen, bone and lung tissue, 2 cases; 8 cases with B symptoms (34.7%). The total effective rate of two cycles of chemotherapy was 100%, the complete remission (CR) rate was 69.6% and the partial remission (PR) rate was 30.4%. The CR rates in stage Ⅰ and stage Ⅱ patients were 100%, which were significantly higher than those in stage Ⅲ and stage Ⅳ patients (P <0.05). The recurrence rate in 23 patients was 46.2% in stage Ⅲ and Ⅳ stage Ⅰ, (P = 0.0098). The recurrence rate was significantly different between patients with and without B symptoms (P = 0.019). In 2 patients with huge mass There was no significant difference between the pathological types and relapse (x2 = 2.695, P> 0.05). Conclusion: The prognosis of children with Hodgkin’s lymphoma is relatively good, but the patients with stage Ⅲ and Ⅳ, combined with B symptoms and large tumors or large mediastinal tumors have a high recurrence rate and should be stratified according to the disease risk so as to achieve a better prognosis .