目的 探讨原发性胃肠道弥漫大B细胞淋巴瘤(PGI-DLBCL)的临床特点、诊治方法及预后.方法 对经手术治疗的40例PGI-DLBCL患者的临床资料进行回顾性分析.结果40例PGI-DLBCL患者中,首发症状以腹痛[15例(37.5%)]、腹部包块[6例(15.0%)]、腹部不适[5例(12.5%)]、腹胀[5例(12.5%)]、呕血黑便[5例(12.5%)]为主.误诊为胃癌15例,肠癌5例,消化道溃疡4例,总误诊率为60.0%(24/40).1、2、3年生存率分别为62.3%、57.5%、52.6%.单因素分析结果显示,临床分期、国际预后指数(IPI)和治疗方法与生存率有关(P<0.01),性别、年龄和原发部位与生存率无关(P>0.05).临床分期Ⅰ~Ⅱ期患者3年生存率明显高于Ⅲ~Ⅳ期患者(68.0%比13.3%),IPI 0~2分患者3年生存率明显高于3~5分患者(66.7%比7.6%),手术联合术后化疗患者3年生存率明显高于单纯手术患者(75.0%比20.0%),差异有统计学意义(P<0.01).结论 PGI-DLBCL患者临床特征不典型,极易误诊.IPI、临床分期、术后是否化疗是预后的影响因素.
Objective To study the clinical characteristics, treatment methods and prognosis of primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL). Methods The clinical data of 40 patients with PGI- DLBCL were retrospectively analyzed. All the cases had received surgery treatment. Results In 40 patients with PGI-DLBCL, the major clinical presentation included abdominal pain in 15 cases (37.5%), abdominal mass in 6 cases (15.0%), abdominal discomfort in 5 cases (12.5%), abdominal distension in 5 cases (12.5%), and hematemesis in 5 cases (12.5%). Fifteen cases were misdiagnosed as gastric cancer, 5 cases as colon cancer, and 4 cases as digestive tract ulcer. The misdiagnosis rate was 60.0% (24/40). The survival rates of 1- , 2- and 3- year were 62.3%, 57.5% and 52.6%. The univariate analyses result showed that the clinical stage, international prognosis index (IPI) and treatment method were associated with survival rate (P<0.01), but the gender, age and disease distribution were not associated with survival rate (P > 0.05). The 3-year survival rate of clinical stage Ⅰ - Ⅱ was significantly higher than clinical stageⅢ-Ⅳ(68.0%vs. 13.3%), the 3-year survival rate of IPI 0-2 scores was significantly higher than 3 - 5 scores (66.7% vs. 7.6%), and the 3- year survival rate of surgery combined with postoperative chemotherapy was significantly higher than simple surgery (75.0%vs. 20.0%), there were statistical differences (P<0.01). Conclusions The patients with PGI- DLBCL have no obvious clinical manifestions and a higher misdiagnosed rate. Modified IPI, clinical stage and surgery combined with postoperative chemotherapy are the influencing factors of prognosis.