CAJ | 학술논문

背景与目的:前驱T淋巴母细胞淋巴瘤(precursor T lymphoblastic lymphoma,T-LBL)是一类高侵袭型恶性淋巴系统肿瘤,部分患者合并有髓系抗原表达,其临床意义值得探索.本文通过分析T-LBL患者合并髓系抗原表达的临床特点以及与近期疗效的关系,探讨其预后价值.方法:收集2000年1月至2008年7月中山大学肿瘤防治中心内科收治的45例初治的T-LBL患者资料,患者年龄5.5～66岁,中位年龄14岁,根据患者骨髓或胸水流式细胞术免疫分型分为髓系抗原阳性表达[My(+)组]和阴性表达[My(-)组]两组.观察和分析髓系抗原的表达与临床特征、近期疗效及2年总生存率的关系.结果:45例TLBL患者中My(+)组18例(40.0%),My(-)组27例(60.0%).全组髓系抗原表达与患者初治的LDH水平呈负相关,与其他临床特征无明显相关性.My(+)组诱导期完全缓解(complete remission,CR)率为38.8%,My(-)组诱导期CR率为70.3%,两组相比差异有统计学意义(P=0.028).My(+)组2年总生存为51.9%,My(-)组2年总生存时间(overallsurvival,OS)为78.7%,两组相比差异有统计学意义(P=0.036).不同年龄亚组分析显示儿童青少年LBL患者髓系抗原阳性组与阴性组在近期疗效和2年总生存率方面无明显差异;成人LBL患者髓系抗原阳性组在近期疗效和2年总生存均低于阴性组患者.单因素和多因素分析显示年龄和髓系抗原表达是T-LBL的不良预后因素.结论:本研究显示髓系抗原阳性表达的成人T-LBL较阴性表达者近期CR率低,2年总生存率较低;而对儿童青少年T-LBL近期疗效和生存率无明显影响.
배경여목적:전구T림파모세포림파류(precursor T lymphoblastic lymphoma,T-LBL)시일류고침습형악성림파계통종류,부분환자합병유수계항원표체,기림상의의치득탐색.본문통과분석T-LBL환자합병수계항원표체적림상특점이급여근기료효적관계,탐토기예후개치.방법:수집2000년1월지2008년7월중산대학종류방치중심내과수치적45례초치적T-LBL환자자료,환자년령5.5～66세,중위년령14세,근거환자골수혹흉수류식세포술면역분형분위수계항원양성표체[My(+)조]화음성표체[My(-)조]량조.관찰화분석수계항원적표체여림상특정、근기료효급2년총생존솔적관계.결과:45례TLBL환자중My(+)조18례(40.0%),My(-)조27례(60.0%).전조수계항원표체여환자초치적LDH수평정부상관,여기타림상특정무명현상관성.My(+)조유도기완전완해(complete remission,CR)솔위38.8%,My(-)조유도기CR솔위70.3%,량조상비차이유통계학의의(P=0.028).My(+)조2년총생존위51.9%,My(-)조2년총생존시간(overallsurvival,OS)위78.7%,량조상비차이유통계학의의(P=0.036).불동년령아조분석현시인동청소년LBL환자수계항원양성조여음성조재근기료효화2년총생존솔방면무명현차이;성인LBL환자수계항원양성조재근기료효화2년총생존균저우음성조환자.단인소화다인소분석현시년령화수계항원표체시T-LBL적불량예후인소.결론:본연구현시수계항원양성표체적성인T-LBL교음성표체자근기CR솔저,2년총생존솔교저;이대인동청소년T-LBL근기료효화생존솔무명현영향.
Background and Objective:Precursor T lymphoblastic lymphoma (T-LBL)is a highly aggressive lymphoma.Myeloid antigen expression was found in some of the patients,and its clinical significance is worth studying.This study was to compare the clinical features.short-term efficacy and survival of T-LBL patients with or without myeloid antigen expression so as to evaluate its prognostic significance.Methods:Forty-five T-LBL patients,with a median age of 14 years,were treated at Sun Yat-sen University Cancer Center between January 2000 and July 2008.These patients were divided into myeloid antigen-positive group(My+group)and myeloid antigennegative group(My-group)based on the flow cytometric(FCM)analysis in bone marrow or pleural fluid.Myeloid antigen expression and its correlation with the short-term efficacy and overall survival were assessed in the two groups.Results:There were 18 patients(40.0%)in the My+group and 27 (60.0%)in the My-group.The myeloid antigen expression was negatively correlated with the initial level of lactate dehydrogenase(LDH),but not with other clinicaI features.The remission rate was lower in the My+group than in the My-group(38.8%vs.70.3%,P=0.028).The 2-year overall survival rate was lower in the My+group than in the My-group(51.9%vs.78.7%,P=0.036).By age subgroup analysis,there were no differences in response and survival rate among children and adolescents with or without myeloid antigen expression.But the remission rate and the 2-year overall survival rate were significantly lower in adult patients with myeloid antigen expression than in patients without it.Univariate and multivariate analysis demonstrated that age and myeloid antigen expression were adverse prognostic factors.Conclusion:Myeloid antigen expression is a predictor of a poor response to chemotherapy,and adverse prognostic factor in adult T-LBL,but not in children with T-LBL.