CAJ | 학술논문

目的探讨原发性乳腺淋巴瘤(PBL)患者临床特征及治疗方法对预后的影响.方法对2003年至2013年所收治的21例PBL患者的临床资料进行回顾性分析.根据治疗方案的不同对患者进行分层分析,比较手术、预防性腰穿鞘注、利妥昔单抗应用对患者疗效和预后的影响.结果 21例患者中6例行乳腺肿块穿刺活检术,2例行乳腺癌改良根治术,其余均行单纯乳腺肿块切除术后经病理学检查明确诊断.其中弥漫大B细胞淋巴瘤(DLBCL) 17例,黏膜相关淋巴组织结外边缘区B细胞淋巴瘤(MALT淋巴瘤)、滤泡性淋巴瘤、Burkitt淋巴瘤、皮下脂膜炎样T细胞淋巴瘤各1例.所有患者中仅1例肿块直径＞7 cm (MALT淋巴瘤患者),其余均＜5 cm.治疗后完全缓解(CR)19例,部分缓解和疾病进展各l例.中位随访14(6～75)个月,21例患者中1例死亡,3年总生存(OS)率为92.3％.化疗+手术组(15例)患者的无进展生存(PFS)时间较单纯化疗组(6例)延长,差异有统计学意义(60个月对22个月,P=0.015),但两组患者的CR率和OS时间差异无统计学意义(P值均＞0.05).20例CD20阳性患者中接受利妥昔单抗治疗者17例,与未接受的3例比较,CR率和PFS、OS时间差异均无统计学意义(P值均＞0.05).8例患者接受预防性腰穿鞘注治疗,与13例未接受者比较,中枢神经系统浸润发生率差异无统计学意义(P=0.381).结论 PBL以DLBCL多见,治疗效果较好,手术治疗仅为明确诊断,并不延长患者OS时间.PBL患者行预防性腰穿鞘注治疗不降低中枢神经系统浸润发生率.
목적 탐토원발성유선림파류(PBL)환자림상특정급치료방법대예후적영향.방법 대2003년지2013년소수치적21례PBL환자적림상자료진행회고성분석.근거치료방안적불동대환자진행분층분석,비교수술、예방성요천초주、리타석단항응용대환자료효화예후적영향.결과 21례환자중6례행유선종괴천자활검술,2례행유선암개량근치술,기여균행단순유선종괴절제술후경병이학검사명학진단.기중미만대B세포림파류(DLBCL) 17례,점막상관림파조직결외변연구B세포림파류(MALT림파류)、려포성림파류、Burkitt림파류、피하지막염양T세포림파류각1례.소유환자중부1례종괴직경＞7 cm (MALT림파류환자),기여균＜5 cm.치료후완전완해(CR)19례,부분완해화질병진전각l례.중위수방14(6～75)개월,21례환자중1례사망,3년총생존(OS)솔위92.3％.화료+수술조(15례)환자적무진전생존(PFS)시간교단순화료조(6례)연장,차이유통계학의의(60개월대22개월,P=0.015),단량조환자적CR솔화OS시간차이무통계학의의(P치균＞0.05).20례CD20양성환자중접수리타석단항치료자17례,여미접수적3례비교,CR솔화PFS、OS시간차이균무통계학의의(P치균＞0.05).8례환자접수예방성요천초주치료,여13례미접수자비교,중추신경계통침윤발생솔차이무통계학의의(P=0.381).결론 PBL이DLBCL다견,치료효과교호,수술치료부위명학진단,병불연장환자OS시간.PBL환자행예방성요천초주치료불강저중추신경계통침윤발생솔.
Objective To analyze the clinical features,therapeutic methods and prognosis of primary breast lymphoma (PBL).Methods Twenty-one PBL patients treated in Ruijin Hospital from January 2003 to December 2013 were included in this study,with 17 diffuse large cell lymphoma (DLBCL),1 mucosa-associated lymphoid tumor (MALT),1 follicular lymphoma (FL),1 Burkitt lymphoma and 1 subcutaneous peniculitis T-cell lymphoma according to the WHO 2008 classification.Of 21 patients,only one patient with MALT has bulged tumor mass (＞7 cm),other patients had tumor mass ＜ 5 cm.Six patients had core needle biopsy of tumor,2 modified radical operation,and others tumor excision for diagnosis.All the patients received chemotherapy.The impacts of surgery,rituximab and prophylaxis with lumbar puncture on the outcomes of patients were analyzed.Survival was estimated using KaplanMeier method and compared by log-rank test.All the results were analyzed by SPSS 10.0.Results Among 21 PBL patients,19 achieved complete remission (CR),1 partial remission (PR) and 1 disease progression (PD).Followed-up till July 2014,with median follow-up of 14 months (6-75 months),only one patient died,with 3-year survival of 92.3％.Compared with chemotherapy alone,the progression-free survival (PFS) of combination therapy (surgery plus chemotherapy) was significant longer (P=0.015),but without statistic differences of CR rate and overall survival (OS) between two groups.Among the 20 patients with CD20-positive tumor cells,17 received Rituximab.PFS and OS,as well as CR rate of PBL had no difference between the treatment with and without Rituximab.The incidence of central nervous system (CNS) infiltration had no difference between patients with and without CNS prophylaxis through lumber-puncture and intrathecal injection.Conclusion With the common subtype of DLBCL,PBL patients had good outcome.Surgery,as a method to obtain tumor samples for diagnosis,could not prolong OS of patients.Therefore,radical operation shouldn' t be recommended.PBL was reported to have high risk of CNS events,but prophylaxis with lumber puncture and intrathecal injection couldn't decrease the incidence of CNS infiltration.