CAJ | 학술논문

目的：探讨儿童非霍奇金淋巴瘤(NHL)临床表现及影响预后的因素。方法收集2004年1月至2013年8月期间确诊的78例NHL患儿的资料，采用Kaplan-Meier方法计算5年无事件生存率(EFS)，用Cox比例风险模型分析年龄、性别、肿瘤大小、免疫分型、B症状、乳酸脱氢酶（LDH）、临床分期等因素对5年EFS的影响。结果78例NHL的中位发病年龄是7岁，男女比例2.90∶1。其中T细胞型25例，B细胞性53例，病理类型以Burkitt淋巴瘤最常见。根据St.Jude淋巴瘤分期，Ⅰ期2例，Ⅱ期9例，Ⅲ期35例，Ⅳ期32例。26例淋巴母细胞淋巴瘤主要以外周淋巴结肿大(80.7%)为首发表现，27例Burkitt淋巴瘤患儿主要以腹腔和口腔牙龈受累。73例患儿进行治疗，化疗2个疗程后，完全缓解66例(90.5%)，部分缓解4例(5.5%)，2例(2.7%)在1个疗程缓解后复发，1例(1.3%)在化疗中出现中枢神经系统浸润。中位随访时间42个月，73例患儿的5年EFS为(67.0±5.5)%。单因素分析显示，B症状、LDH水平、临床分期与患儿预后显著相关(P<0.05)，而年龄、性别、肿块大小等与预后无关(P>0.05)，多因素分析显示，LDH水平、临床分期影响患儿预后(OR=3.34，95％CI2.275~10.683，P<0.01；OR=4.354，95%CI 1.519~12.475，P<0.01)。结论儿童NHL临床表现多样化，初诊时LDH水平、临床分期是影响预后的重要因素。
목적：탐토인동비곽기금림파류(NHL)림상표현급영향예후적인소。방법수집2004년1월지2013년8월기간학진적78례NHL환인적자료，채용Kaplan-Meier방법계산5년무사건생존솔(EFS)，용Cox비례풍험모형분석년령、성별、종류대소、면역분형、B증상、유산탈경매（LDH）、림상분기등인소대5년EFS적영향。결과78례NHL적중위발병년령시7세，남녀비례2.90∶1。기중T세포형25례，B세포성53례，병리류형이Burkitt림파류최상견。근거St.Jude림파류분기，Ⅰ기2례，Ⅱ기9례，Ⅲ기35례，Ⅳ기32례。26례림파모세포림파류주요이외주림파결종대(80.7%)위수발표현，27례Burkitt림파류환인주요이복강화구강아간수루。73례환인진행치료，화료2개료정후，완전완해66례(90.5%)，부분완해4례(5.5%)，2례(2.7%)재1개료정완해후복발，1례(1.3%)재화료중출현중추신경계통침윤。중위수방시간42개월，73례환인적5년EFS위(67.0±5.5)%。단인소분석현시，B증상、LDH수평、림상분기여환인예후현저상관(P<0.05)，이년령、성별、종괴대소등여예후무관(P>0.05)，다인소분석현시，LDH수평、림상분기영향환인예후(OR=3.34，95％CI2.275~10.683，P<0.01；OR=4.354，95%CI 1.519~12.475，P<0.01)。결론인동NHL림상표현다양화，초진시LDH수평、림상분기시영향예후적중요인소。
ObjectiveTo explore the clinical features and factors inlfuencing the prognosis of childhood non-Hodgkin's lymphoma (NHL).MethodsPathologically diagnosed 78 pediatric patients with NHL and treated in the Afifliated Hospital of Qingdao University from January 2004 to August 2013 were collected and analyzed. Patients were grouped according to age, sex, tumor size, immunologic classiifcation, B-symptoms, LDH, hemoglobin and clinical staging. The 5-years event-free survival rate (EFS) were calculated and analyzed by Kaplan-Meier method, and the difference of the survival rate between groups were com-pared. Using Cox proportional hazards model, we analyzed the possible factors that might inlfuence 5-years event-free survival rate EFS , such as age and clinical staging. TheOR value and the 95%CI were calculated.ResultsAmong the 78 cases, median age of onset is 7 years old, male to female ratio is 2.90:1, there are 25 cases of T-cell type and 53 cases of B-cell type. According to pathological types,Burkitt lymphoma is the most common (34.6%), followed by T-lymphoblastic lymphoma (20.5%), diffuse large B-cell lymphoma (11.5%). According to the St. Jude malignant lymphoma staging system, there are 2 cases in stage I, 9 in stageⅡ, 35 in stageⅢ and 32 in stageⅣ. Swelling of periphery lymph node (80.7%) was observed as initial symptom in 26 cases of lymphoblastic lymphoma. Among 45 cases of mature B-cell tumor, the main clinical feature including abdominal cavity and gingival were observed in 27 cases of Burkitt lymphoma. Among the 73 cases received treatments, 66 cases (90.5%) attained CR (complete remission) and 4 cases (5.5%) attained PR (partial remission) by cytology and radiographic assessment after two course of combined chemotherapy, 2 cases (2.7%) rapidly relapsed after the remisson of one course treatment, 1 case (1.3%) appeared the central nervous system inifltration in the chemotherapy. With median follow-up time of 42 months, the 5-year EFS of the 73 cases was (67.0+5.5)%. Single factor analysis showed that B-symptom, LDH, and clinical staging were signiifcantly correlated with prognosis (P<0.05), while age, sex, tumor size, hemoglobin and immune classiifcation was independent of prog-nosis (P>0.05). Multiple factor analysis showed that LDH and clinical staging inlfuenced the prognosis (OR=3.34,95%CI 2.275?10.683,P<0.01;OR=4.354,95%CI 1.519?12.475,P<0.01) .Conclusionclinical features of childhood NHL are variable. LDH and clinical staging at primary diagnosis are important factors affecting the prognosis.