CAJ | 학술논문

目的研究原发睾丸非霍奇金淋巴瘤(NHL)的临床特征及预后因素.方法回顾性分析2005年1月至2012年12月在北京大学肿瘤医院住院治疗的初治21例原发睾丸NHL患者的临床资料,总结其临床特征并分析其预后因素.结果 21例患者年龄34～86岁,中位年龄59岁.其中Ⅰ期患者8例,Ⅱ期患者2例,Ⅳ期患者11例；4例患者合并B症状；12例患者出现睾丸以外的结外部位受侵；起病时乳酸脱氢酶(LDH)升高者6例；国际预后指数(IPI)评分0～1分(低危组)10例,3分(中高危组)10例,4分(高危组)1例.15例患者诊断时行手术切除；7例患者在化疗结束后行局部放疗；15例患者在治疗过程中接受预防性鞘内注射.全组病理诊断均为弥漫大B细胞淋巴瘤(DLBCL),其中11例为非生发中心来源.一线治疗采用R-CHOP(利妥昔单抗、环磷酰胺、阿霉素、长春新碱、泼尼松)或CHOP类方案化疗,获完全缓解率为85.7％.随访6～58个月,中位随访时间18个月.患者1、2、3年生存率分别为100％、80％和60％.Log-Rank检验显示一线化疗方案是否含有利妥昔单抗为独立预后因素(P=0.038),而分期(P =0.275)、起病时LDH(P=0.179)以及β2-微球蛋白(β2-MG) (P =0.229)是否升高、IPI(P =0.275)这4项因素虽有对生存产生影响的趋势,但差异无统计学意义.结论原发睾丸NHL预后通常较差,一线化疗方案是否含有利妥昔单抗为患者预后因素.
목적 연구원발고환비곽기금림파류(NHL)적림상특정급예후인소.방법 회고성분석2005년1월지2012년12월재북경대학종류의원주원치료적초치21례원발고환NHL환자적림상자료,총결기림상특정병분석기예후인소.결과 21례환자년령34～86세,중위년령59세.기중Ⅰ기환자8례,Ⅱ기환자2례,Ⅳ기환자11례；4례환자합병B증상；12례환자출현고환이외적결외부위수침；기병시유산탈경매(LDH)승고자6례；국제예후지수(IPI)평분0～1분(저위조)10례,3분(중고위조)10례,4분(고위조)1례.15례환자진단시행수술절제；7례환자재화료결속후행국부방료；15례환자재치료과정중접수예방성초내주사.전조병리진단균위미만대B세포림파류(DLBCL),기중11례위비생발중심래원.일선치료채용R-CHOP(리타석단항、배린선알、아매소、장춘신감、발니송)혹CHOP류방안화료,획완전완해솔위85.7％.수방6～58개월,중위수방시간18개월.환자1、2、3년생존솔분별위100％、80％화60％.Log-Rank검험현시일선화료방안시부함유리타석단항위독립예후인소(P=0.038),이분기(P =0.275)、기병시LDH(P=0.179)이급β2-미구단백(β2-MG) (P =0.229)시부승고、IPI(P =0.275)저4항인소수유대생존산생영향적추세,단차이무통계학의의.결론 원발고환NHL예후통상교차,일선화료방안시부함유리타석단항위환자예후인소.
Objective To explore the clinical characteristics and prognosis of patients with primary testicular non-Hodgkin's lymphoma.Methods The clinical profiles and prognostic factors of 21 cases newly diagnosed as primary testicular non-Hodgkin's lymphoma at Peking University Cancer Hospital from January 2005 to December 2012 were retrospectively analyzed.Results Their median age was 59 (34-86) years.And they were classified as Ann Arbor stage Ⅰ (n =8),stage Ⅱ (n =2) and stage Ⅳ (n =11).There were B symptoms (n =4),extranodal involvement outside testis (n =12) and elevated lactate dehydrogenase (LDH) at diagnosis (n =6).The scores of international prognostic index (IPI) were 0-1 point (n =10),3 points (n =10) and 4 points (n =1).The regimens included orchidectomy as the initial treatment (n =15),chemotherapy followed by radiotherapy (n =7) and CNS prophylaxis during treatment (n =15).All patients were pathologically diagnosed as diffuse large B-cell lymphoma.And 11 cases belonged to the non-germinal center B cell-like subgroup.First-line chemotherapy was either R-CHOP (rituximab,cyctophosphamide,doxornbicin,vincristine and prednisolone) or CHOP-like-based regimen.Complete response was achieved in 85.7％ of patients.The median follow-up period was 18 (6-58) months.The 1,2 and 3-year survival rates were 100％,80％ and 60％ respectively.Statistical analysis showed that the firstline chemotherapy with rituximab was a prognostic factor (P =0.038).Other factors included stage (P =0.275),LDH level (P =0.179),β2-microglobulin level (P =0.229) and IPI (P =0.275).Conclusions The prognosis of primary testicular non-Hodgkin's lymphoma is usually poor.The first-line chemotherapy with rituximab is a prognostic factor.