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目的探讨原发乳腺非霍奇金淋巴瘤(PNHLB)的临床病理特征、治疗方案及预后因素。方法收集34例PNHLB住院患者的临床资料,并进行电话或门诊随访,回顾性分析总结患者的临床及病理特征、治疗和生存情况。结果 34例患者均为女性,中位年龄46岁。临床分期Ⅰ期19例(56%),Ⅱ期8例(24%),Ⅲ期1例(3%),Ⅳ期6例(18%)。部分患者进行了Ki-67、Bcl-2、CD10、Bcl-6及Mum-1免疫组化检测。治疗方法包括单纯手术(2例)、手术+化疗(14例)、手术+化放疗(7例)、化疗+放疗(4例)、联合利妥昔单抗(22例)、联合预防性鞘注(2例)及造血干细胞移植(3例)。随访时间0.5~149.0个月,全组死亡8例,中位总生存期(OS)未达到,中位无进展生存期(PFS)为86.0个月(95%CI=16.1~155.9个月)。1、2、3、5年总生存率分别为90.3%、87.0%、83.6%及73.3%,无进展生存率分别为75.1%、61.5%、61.5%及51.0%。Log-rank单因素分析发现肿瘤原发部位、分期、IPI评分与中位OS有关,初始治疗后是否达CR及IPI评分与中位PFS有关。结论 PNHLB多为B细胞来源,其中弥漫大B细胞型最多见,目前主要治疗模式为手术联合放化疗及利妥昔单抗靶向治疗,化疗多采用CHOP方案,同时预防性鞘注可能给患者带来生存获益。
Objective To investigate the clinicopathological features, treatment and prognostic factors of primary breast non-Hodgkin’s lymphoma (PNHLB). Methods The clinical data of 34 inpatients with PNHLB were collected and followed up by phone or clinic. The clinical and pathological features, treatment and survival of the patients were retrospectively analyzed. Results All 34 patients were female, with a median age of 46 years. There were 19 cases (56%) in stage I, 8 cases (24%) in stage II, 1 (3%) in stage III and 6 (18%) in stage IV. Some patients had Ki-67, Bcl-2, CD10, Bcl-6 and Mum-1 immunohistochemical detection. The treatment included surgery alone (2 cases), operation plus chemotherapy (14 cases), operation + chemoradiotherapy (7 cases), chemotherapy plus radiotherapy (4 cases), combined rituximab (22 cases) Note (2 cases) and hematopoietic stem cell transplantation (3 cases). The follow-up time ranged from 0.5 to 149.0 months. All patients died in 8 cases. The median overall survival (OS) was not achieved. The median progression-free survival (PFS) was 86.0 months (95% CI = 16.1 to 155.9 months). The overall survival rates at 1, 2, 3 and 5 years were 90.3%, 87.0%, 83.6% and 73.3%, respectively. The progression-free survival rates were 75.1%, 61.5%, 61.5% and 51.0% respectively. Log-rank univariate analysis showed that the primary tumor location, staging and IPI score were related to the median OS. Whether CR and IPI scores were related to the median PFS after initial treatment was correlated with the primary tumor. Conclusions PNHLB is mostly the source of B cells, of which diffuse large B cell type is the most common. At present, the main treatment modality is surgery combined with chemoradiation and targeted therapy with rituximab. CHOP is the most frequently used chemotherapy and prophylactic intrathecal injection may give patients Bring survival benefits.