原发性胃恶性淋巴瘤患者的临床特点及预后危险因素分析

To Analyze the Clinical Characteristics and Prognostic Risk Factors of Patients with Primary Gastric Malignant Lymphoma

摘要: 目的：分析原发性胃恶性淋巴瘤(PGL)的临床特征、治疗方法的选择及影响预后的因素。方法：回顾性分析徐州市中心医院2012年11月至2020年11月收治的72例PGIL患者的临床资料，并探讨患者初诊时临床特征及其与预后之间的关系。结果：72例PGL患者中男36例，女36例，男女比例为1:1。发病中位年龄60 (30~78)岁。发病部位以胃窦30.5% (22例)最常见。病理类型以B细胞淋巴瘤为主，占86.1%。随访时间3~110个月不等，中位随访56个月。PGL患者1年、3年预期生存率分别为98.3%、81.6%，单因素分析显示，年龄 > 60岁(p = 0.028)、临床分期为III/IV期 (p = 0.001)、B症状(p < 0.001)、国际预后指数(IPI)评分3~5分(p = 0.028)、ALB < 35 g/l (p = 0.003)、高水平LDH (p = 0.003)、病理分型为T细胞淋巴瘤(p = 0.006)为影响总生存期的预后危险因素，差异具有显著性(p < 0.05)。COX回归模型多因素分析显示，国际预后指数(IPI)评分3~5分(p = 0.022)为预后不良的独立危险因素。结论：PGL在中老年男性更常见，以DLBCL最常见的病理类型。年龄 > 60岁、临床分期处于III/IV期、IPI指数 ≥ 3、LDH表达高水平、ALB降低、B症状、T细胞源性的预后较差。IPI评分3~5分为预后不良的独立危险因素。

Abstract: Objective: To analyze the clinical characteristics, treatment choice and prognostic factors of primary gastric malignant lymphoma (PGL). Methods: The clinical data of 72 patients with PGL admitted to Xuzhou Central Hospital from November 2012 to November 2020 were retrospectively analyzed, and the clinical characteristics of the patients at their initial diagnosis and their relationship with prognosis were discussed. Results: Among the 72 PGL patients, 36 were male and 36 were female, the ratio of male to female was 1:1. The median age of onset was 60 (30~78) years. The most common site was antrum 30.5% (22 cases). The pathological type was B-cell lymphoma, accounting for 86.1%. The 1-year and 3-year expected survival rates of PGIL patients were 98.3%, 81.6%, respectively, according to univariate analysis. Age > 60 years old (p = 0.028), the clinical stage for III/IV symptoms (p = 0.001), B Symptoms (p < 0.001), the international prognostic index (IPI) score 3 to 5 points (p = 0.028), ALB < 35 g/l (p = 0.003), high levels of LDH (p = 0.003), pathological classification for T cell lymphoma (p = 0.006) risk factors to influence the outcome of overall survival, with significant difference (p < 0.05). Multivariate analysis of COX regression model showed that the international prognostic index (IPI) score 3 to 5 points (p = 0.028) was an independent risk factor for poor prognosis. Conclusion: PGIL is more common in middle-aged and elderly men, especially in stomach, among which DLBCL is the most common pathological type. Age > 60 years of age, clinical stage III/IV stage, IPI index ≥ 3, LDH expression or high levels, B Symptoms, B and T cell source and ALB < 35 g/l. IPI index ≥ 3 is an independent risk factor for poor prognosis.