CAJ | 학술논문

目的总结儿童淋巴母细胞淋巴瘤(LBL)诊断治疗方案的远期疗效及临床特征.方法前瞻性制订诊断治疗方案,连续性积累病例,分析总结1998年11月至2010年10月收治的70例儿童LBL资料,其中T细胞型65例,B细胞型5例.22例采用CCCG-97方案化疗,48例采用CCCG-2002方案化疗.参照St.Jude分期标准进行分期,将患儿分为高、中、低危3组,根据分组分别给予不同强度的治疗方案.单因素分析法分析可能与预后相关的因素.结果 70例患儿诊断时中位年龄8(1.5～14)岁,确诊时Ⅰ～Ⅱ期6例,Ⅲ期41例,Ⅳ期23例(伴骨髓浸润15例,伴多发性骨转移8例).随访至2011年12月31日,无病生存者平均随访时间62.5(14～161)个月,中位随访时间48个月.1年生存率74.3％;累计5年无事件生存率64.1％;化疗期间13例患儿出现严重不良反应,其中8例为明确病原菌的脓毒血症,4例为需要重症监护治疗的严重感染,化疗不良反应相关死亡l例.Kaplan-Meier法绘制生存曲线显示早期缓解(化疗第33天评估)及诱导完成后缓解情况与预后显著相关(P值均＜0.05).结论儿童LBL纵隔原发多见,确诊时90％的患儿为Ⅲ～Ⅳ期,本组患儿5年无事件生存率为64.1％,治疗早期反应与远期预后相关.
목적 총결인동림파모세포림파류(LBL)진단치료방안적원기료효급림상특정.방법 전첨성제정진단치료방안,련속성적루병례,분석총결1998년11월지2010년10월수치적70례인동LBL자료,기중T세포형65례,B세포형5례.22례채용CCCG-97방안화료,48례채용CCCG-2002방안화료.삼조St.Jude분기표준진행분기,장환인분위고、중、저위3조,근거분조분별급여불동강도적치료방안.단인소분석법분석가능여예후상관적인소.결과 70례환인진단시중위년령8(1.5～14)세,학진시Ⅰ～Ⅱ기6례,Ⅲ기41례,Ⅳ기23례(반골수침윤15례,반다발성골전이8례).수방지2011년12월31일,무병생존자평균수방시간62.5(14～161)개월,중위수방시간48개월.1년생존솔74.3％;루계5년무사건생존솔64.1％;화료기간13례환인출현엄중불량반응,기중8례위명학병원균적농독혈증,4례위수요중증감호치료적엄중감염,화료불량반응상관사망l례.Kaplan-Meier법회제생존곡선현시조기완해(화료제33천평고)급유도완성후완해정황여예후현저상관(P치균＜0.05).결론 인동LBL종격원발다견,학진시90％적환인위Ⅲ～Ⅳ기,본조환인5년무사건생존솔위64.1％,치료조기반응여원기예후상관.
Objective To summarize long-term outcomes of childhood lymphoblastic lymphoma (LBL) with protocol CCCG-97 and-2002.Methods From November 1998 to October 2010,70 consecutive newly diagnosed childhood LBL (5 B-LBL and 65 T-LBL) were enrolled in this study,in which 22 received CCCG-97 and 48 CCCG-2002 protocols.St.Jude staging system was adopted.Patients were divided into three risk groups based on clinical stage and serum LDH,and received chemotherapy with different intensity.The factors,which were possibly associated with the prognosis,were analyzed.The survival rates were evaluated by Kaplan-Meier analysis.Results The patients were 1.5 to 14 years old with the median age of 8 years old.They were evaluated as stage Ⅰ-Ⅱ for 6,stage Ⅲ41,and stage Ⅳ23 (15 were BM positive and 8 multiple bone metastases).Until Dec.3 1th,201 1,the mean follow-up was 62.5 months (range,14 to 161 months) with the median follow-up of 48 months.1-year overall survival (OS) was 74.3％,and 5-year event-free survival (EFS) 64.1％ (abundance as event).Thirteen patients were complicated with serious condition during chemotherapy and 1 died of complication.Univariate analysis indicated that delayed and/or non-completed response on days 33 and 63 of induction was the unfavorable prognostic factor.Conclusion Primary LBL usually located in the mediastinum.90％ of the patients was at advanced stage Ⅲ-Ⅳ at first presentation.The 5-year EFS was 64.1％.Patients not achieved CR at days 33 and 63 at the end of induction was a poor prognostic factor.