【作者】 吴丹；

【导师】 徐旸；

【作者基本信息】 浙江大学 ， 临床医学（专业学位）， 2017， 硕士

【摘要】 目的:本研究旨在深入了解胃肠道淋巴瘤(gastrointestinal lymphoma,GIL)的临床特点,比较不同的治疗策略的临床效果,探讨胃肠道淋巴瘤的预后因素。材料和方法:回顾性分析2011年1月至2015年12月浙江大学医学院附属第二医院经组织病理确诊的60例胃肠道淋巴瘤患者的临床资料,包括临床表现、实验室检查、病理类型、临床分期、治疗方案、随访资料等数据。采用SPSS19.0软件,生存分析应用Kaplan-Meier法,率的比较采用卡方检验,生存率的比较用Log-rank检验,采用COX部分风险模型进行多因素分析,P<0.05具有统计学意义。结果:60例胃肠道淋巴瘤患者中,男女比为1.61:1;发病年龄24-85岁,中位年龄为60岁;胃、肠淋巴瘤比为2:3;临床最常见的症状为腹痛(71.7%),其次为腹胀(26.7%)、体重下降(23.3%)、黑便(16.7%)等,肠淋巴瘤易发生肠穿孔、梗阻及出血等严重并发症;病理类型最常见的是弥漫大B细胞淋巴瘤(66.7%),其次为结外黏膜相关组织边缘区淋巴瘤(15.0%),T细胞淋巴瘤较少见;Lugano分期早期(Ⅰ期+Ⅱ期)28例,进展期(IIE+IV)32例;所有患者均接受了治疗,其中单纯手术14例(23.3%),单纯化疗21例(35.0%),手术联合化疗25例(41.7%)。单因素预后分析结果表明胃淋巴瘤(P=0.02)、LDH水平正常(P=0.002)、IPI评分低于3分(P=0.006)、B细胞淋巴瘤(P==0.000)、接受化疗(P=0.000)可以使GIL患者的PFS及OS显著延长,B细胞淋巴瘤(P=0.000)及接受化疗(P=0.007)可以使早期GIL患者的PFS及OS显著延长,而胃淋巴瘤(P=0.046)、PS评分低于 2 分(P=0.009)、IPI 评分低于 3 分(P==0.014)、LDH 水平正常(P=0.000)、B细胞淋巴瘤(P=0.002)及接受化疗(P-=0.002)则显著延长进展期GIL患者的PFS及OS。多因素预后分析结果表明病理类型及LDH水平为GIL患者预后的独立因素(P<0.01)。结论:胃淋巴瘤、LDH水平正常、IPI评分低于3分、B细胞淋巴瘤及接受化疗的GIL患者的PFS及OS延长。另外,PS评分对进展期GIL患者的PFS及OS有较好的预测价值。T细胞淋巴瘤及LDH升高是影响GIL患者总生存的独立危险因素。更多还原

【Abstract】 Purpose:The purpose of this study is to characterize the clinical features of gastrointestinal lymphoma(GIL),to analyze the impact of treatment strategies on the patient outcomes,and to explore prognostic factors for GIL.Material and Methods:We reviewed 60 cases of GIL that were pathologically confirmed in the Second Affiliated Hospital,Zhejiang University School of Medicine from January 2011 to December 2015.For each patient,the data on clinical manifestation,laboratory results,pathology,clinical stage,therapeutic regimen and survival were collected.With SPSS 19.0 software,chi-square test was used for ratio comparison,survival was estimated from Kaplan-Meier curves and compared using the log-rank test,the COX proportional hazard model in the multivariate analysis to identify prognostic factors,P<0.05 was considered statistically significant.Results:In our cohort of 60 patients with GIL,the median age was 60 years(range 24 to 85 years),the male-to-female ratio was 1.61:1,and the gastric-to-intestinal involvment ratio was 2:3.The most common clinical manifestation was abdominal pain(71.7%),followed by abdominal distension(26.7%),loss of weight(23.3%),melena(16.7%);severe complications such as perforation,obstruction and hemorrhage occured mainly in intestinal lymphoma.As for pathological subtypes,diffuse large B cell lymphoma was the most common(66.7%),followed by mucosa-associated lymphoid lymphoma(15.0%),while T cell lymphoma was rare.According to the Lugano staging system,28 cases were assigned to early stage(Ⅰ+Ⅱ),and 32 were at advanced stage(IIE+IV).Fourteen(23.3%)patients with GILs underwent surgery only,21(35.0%)received chemotherapy alone,and 25(41.7%)received surgery plus chemotherapy.Univariate analysis showed that gastric involvement(P=0.02),normal level of lactic dehydrogenase(P=0.002),International Prognostic Index less than 3(P=0.006),B cell type(P=0.000)and chemotherapy(P=0.000)significantly prolong PFS and OS for all GIL patients.Multivariate analysis showed that pathological subtypes and levels of lactic dehydrogenase were the independent prognostic factors for GIL patients(P<0.01)。Conclusions:Gastric involvment,normal level of lactic dehydrogenase,International prognostic index less than 3,B cell subtype and chemotherapy prolong PFS and OS of GIL patients.Likewise,performance status had great predictive value for PFS and OS in advanced-stage GIL.T cell lymphoma and increased level of lactate dehydrogenase were the independent risk factors for OS.更多还原