原发胃肠道淋巴瘤患者25例临床分析

Clinical Analysis of 25 Cases of Primary Gastrointestinal Lymphoma (PGI) Patients

摘要: 目的：分析原发胃肠道淋巴瘤患者的临床特征、治疗效果与预后。方法：收集我院2012年9月至2025年1月诊治的25例PGI患者的临床资料和实验室指标等，对临床特征、治疗效果与预后进行回顾性分析，影响预后的单因素分析采用Kaplan-Meier法，多因素分析采用Cox比例风险模型，探讨相关临床指标对PGI患者预后的影响。结果：PGI-DLBCL患者占PGI-NHL患者人数的52%，是PGI-NHL的主要病理类型，患病人群多为中老年男性，临床症状主要表现为腹痛(52%)、腹部不适(24%)、腹胀(12%)及消化道出血症状(黑便8%)，病变多累及胃(44%)，回肠8例(32%)及盲肠(24%)，B症状发生率较低(68%)。12例(48%)患者为中高危，10例(40%)分期为III~IV。在中位随访时间9.47个月里，有11例患者达CR，2例患者达PR，2例达SD，10例出现PD，仅有1例患者因为疾病进展而死亡。所有患者的2年PFS率和2年OS率分别为45.3%和94.4%。单因素分析显示，LDH水平、Lugano分期和Ki67与PGL患者预后有关。将上述变量纳入多因素COX回归模型，结果显示，LDH水平升高，Lugano分期为III~IV是PGL患者预后的独立危险因素。结论：1. PGL患者的肿瘤细胞来源以B细胞为主，DLBCL为其最常见的病理类型。患者人群多为中老年男性，临床症状主要表现为腹痛，且B症状发生率较低。2. LDH水平的升高和Lugano分期较晚(III~IV)是PGL患者预后的不利因素，可能有助于医生对患者进行风险分层，采取更为个性化的治疗措施。

Abstract: Objective: To analyze the clinical characteristics, treatment outcomes, and prognosis of patients with primary gastrointestinal lymphoma (PGI). Methods: We collected clinical data and laboratory indicators from 25 PGI patients diagnosed and treated at our hospital between September 2012 and January 2025. A retrospective analysis was performed on the clinical features, treatment efficacy, and prognosis. Univariate analysis of prognostic factors was conducted using the Kaplan-Meier method, while multivariate analysis was performed with the Cox proportional hazards model to explore the influence of clinical indicators on the prognosis of PGI patients. Results: Among PGI-NHL patients, 52% were diagnosed with PGI-DLBCL, which is the most common pathological type. The majority of the affected patients were middle-aged and elderly males. The most common clinical symptoms were abdominal pain (52%), abdominal discomfort (24%), bloating (12%), and gastrointestinal bleeding (melena in 8%). The lesions predominantly affected the stomach (44%), ileum (32%), and cecum (24%). The incidence of B symptoms was relatively low (68%). Twelve patients (48%) were classified as intermediate to high-risk, and 10 patients (40%) were staged as III~IV. During a median follow-up period of 9.47 months, 11 patients achieved complete remission (CR), 2 achieved partial remission (PR), 2 had stable disease (SD), and 10 showed progressive disease (PD). Only one patient died due to disease progression. The 2-year progression-free survival (PFS) rate and 2-year overall survival (OS) rate were 45.3% and 94.4%, respectively. Univariate analysis revealed that LDH levels, Lugano staging, and Ki67 were associated with prognosis. In multivariate Cox regression analysis, elevated LDH levels and advanced Lugano staging (III-IV) were identified as independent prognostic factors for PGI patients. Conclusion: 1. PGI tumors are primarily of B-cell origin, with DLBCL being the most common pathological type. The affected population is predominantly middle-aged and elderly males, and clinical symptoms are mainly characterized by abdominal pain, with a low incidence of B symptoms. 2. Elevated LDH levels and advanced Lugano staging (III~IV) are unfavorable prognostic factors in PGI patients. These factors may help clinicians in risk stratification and the development of more personalized treatment strategies.