50例胃原发性恶性淋巴瘤临床特点分析

摘要

目的:探讨原发性胃淋巴瘤的临床特点,提高原发性胃淋巴瘤的诊治水平.方法:回顾性分析中南大学湘雅医院肿瘤科2005年9月至2009年9月收治的50例胃原发性恶性淋巴瘤.结果:原发性胃恶性淋巴瘤临床表现包括腹痛、上腹部不适、呕吐、黑便、食欲减退、发热、乏力、消瘦等,其中最主要临床表现为腹痛.50例胃原发性恶性淋巴瘤中,1例为外周T细胞性淋巴瘤；49例为B细胞性淋巴瘤,其中弥漫大B细胞性淋巴瘤(diffuse large B cell lymphoma,DLBCL) 34例,黏膜相关淋巴组织淋巴瘤(mucosa associated lymphoid tissue lymphoma,MALT) 13例,DLBCL合并MAIT淋巴瘤2例.50例胃原发淋巴瘤患者中共12例接受手术治疗,所有患者均接受化学治疗.49例DLBCL患者中14例接受利妥昔单抗联合化学治疗,35例单纯化学治疗,利妥昔单抗联合化学治疗患者的2年总生存率优于单纯化学治疗患者(85.7％ vs 77.1％,P＜0.05).临床分期Ⅰ～Ⅱ期的患者2年总生存率优于临床分期Ⅲ～Ⅳ期的患者(90.9％ vs 71.4％,P＜0.05).结论:原发性胃恶性淋巴瘤患者临床表现以消化道症状为主,但无特异性,腹痛是最常见的表现.临床以组织病理检查为金标准,最常见病理类型为DLBCL.治疗选择以化学治疗为主的综合治疗,患者预后与临床分期、是否联合美罗华化学治疗相关.治疗后50例患者的2年总生存率达80.0％.%Objective: To analyze the clinical characteristics of primary gastric lymphoma (PGL) and to improve its diagnosis and treatment.Methods: The clinical manifestations, diagnosis, treatments and history of 50 PGL patients, who were hospitalized from September 2005 to September 2009, were reviewed and analyzed. Results: The main manifestation of PGL was epigastric pain with infrequent systemic symptoms, such as stomachache, abdominal discomfort, vomit, black stool, loss of appetite, fever, feeble, and skinny. Pathological examination indicated that only 1 patient had T cell lymphoma while the rest 49 had B cell lymphoma. Fourteen had mucosa-associated lymphoid tissue lymphoma (MALT), 35 had diffuse large B cell lymphoma (DLBCL), and 2 had both DLBCL and MALT (DLBCML). All the 50 patients received chemotherapy, and 12 underwent surgical treatment besides chemotherapy. Fourteen out of the 49 patients with B cell lymphoma received rituximab together with chemotherapy, and 35 received chemotherapy alone. The 2-year survival rate in the patients receiving rituximab together with chemotherapy was higher than that in the patients receiving chemotherapy alone (85.7% vs 77.1%, P< 0.05). The 2-year survival rate in patients of clinical stage Ⅰ-Ⅱ was higher than that in patients of clinical stage Ⅲ -Ⅳ (90.9% vs 71.4%, P< 0.05). Conclusion: The main clinical manifestation of PGL patients is non-specific gastrointestinal symptoms, among which abdominal pain is most common. The clinical examination mainly relies on pathological examinations, and the most common pathological type of primary gastric lymphoma is DLBCL. The main treatment is chemotherapy, and the prognosis is related to the clinical stage and the use of rituximab. After the treatment, the 2-year survival rate in the 50 patients reaches 80.0%.