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目的:分析原发骨淋巴瘤(PBL)的临床病理特征及预后相关因素。方法:回顾性分析19例PBL患者的临床病理资料,分析总结其临床病理特征及预后因素。结果:119例患者中位发病年龄为51(15~78)岁。主要病理类型为弥漫大B细胞淋巴瘤,共15例(78.9%),其中非生发中心型9例(60.0%),生发中心型6例(40.0%)。首发症状最常见为骨痛或活动障碍(18/19,94.7%)。单病灶骨受累14例(73.7%),多病灶骨受累5例(26.3%)。单病灶受累最常见部位是股骨,有4例(28.6%),其次为骨盆3例(21.4%)、脊椎3例(21.4%)。Ann Arbor临床分期Ⅰ~Ⅱ期占52.6%,Ⅳ期占47.4%。15例行PET-CT检查,其中Ⅳ期7例(46.7%)。217例接受联合化疗,另2例仅接受手术剔除修复治疗。近期疗效显示9例(52.9%)达完全缓解(CR),7例(41.2%)达部分缓解,1例(5.9%)疾病进展。3年龄与CR率有关(P<0.05),而性别、临床分期、IPI评分、肿瘤细胞起源、血清β2-微球蛋白、乳酸脱氢酶、铁蛋白水平及是否应用利妥昔单抗体与CR率无明显相关性(P>0.05)。中位随访15(2~60)个月,其中16例存活,2例死亡,1例失访;中位无进展时间为16(4~60)个月。年龄及应用利妥昔单抗是重要的预后因素,初始诱导化疗CR患者可能总生存更佳,但差异无统计学意义(P=0.093);肿瘤细胞起源与总生存无关。结论:PBL主要病理类型为弥漫大B细胞淋巴瘤,年龄与治疗CR率相关,年龄及联合利妥昔单抗治疗是重要的预后相关因素。
Objective: To analyze the clinicopathological features and prognostic factors of primary bone lymphoma (PBL). Methods: The clinical and pathological data of 19 patients with PBL were retrospectively analyzed. The clinicopathological features and prognostic factors were analyzed. Results: The median age of onset of 119 patients was 51 (15-78) years. The main pathological type was diffuse large B cell lymphoma, 15 cases (78.9%), including 9 cases of non-germinal center type (60.0%) and 6 cases of germinal center type (40.0%). The first symptom was the most common bone pain or mobility disorder (18/19, 94.7%). Fourteen cases (73.7%) had single lesion involvement and 5 cases (26.3%) had multiple lesion involvement. The most common site of single lesion involvement was femur, with 4 cases (28.6%) followed by pelvis in 3 cases (21.4%) and spine in 3 cases (21.4%). Ann Arbor clinical stage Ⅰ ~ Ⅱ accounted for 52.6%, Ⅳ period accounted for 47.4%. Fifteen patients underwent PET-CT examinations, of which 7 were stage IV (46.7%). 217 received combined chemotherapy, and the other 2 received only surgical excision and repair. The recent results showed complete remission (CR) in 9 cases (52.9%), partial remission in 7 cases (41.2%) and disease progression in 1 case (5.9%). 3 age and CR rate (P <0.05), and gender, clinical stage, IPI score, tumor cell origin, serum β2-microglobulin, lactate dehydrogenase, ferritin levels and the use of rituximab and CR No significant correlation (P> 0.05). The median follow-up was 15 (2-60) months, of which 16 survived, 2 died and 1 lost follow-up. The median progression-free time was 16 (4 to 60) months. Age and application of rituximab is an important prognostic factor, initial induction chemotherapy CR patients may have better overall survival, but the difference was not statistically significant (P = 0.093); tumor cell origin has nothing to do with the overall survival. CONCLUSION: The main pathological type of PBL is diffuse large B-cell lymphoma. The age is related to the treatment of CR rate. Age and the combination of rituximab therapy are important prognostic factors.