原发性中枢神经系统淋巴瘤25例诊断和治疗的临床分析

发布时间：2018-04-10 18:16

本文选题：原发性中枢神经系统淋巴瘤 + 诊断　；参考：《吉林大学》2014年硕士论文

【摘要】：原发性中枢神经系统淋巴瘤（primary central nervous system lymphoma,PCNSL）是一种较罕见的中枢神经系统恶性肿瘤，目前临床诊断尚有困难，治疗效果不令人满意，深入研究PCNSL的临床特点、诊断要点及有效治疗方法，具有重要临床应有价值。目的：分析PCNSL的临床特征及治疗效果，旨在提高临床上对本病诊断和治疗的认识，进一步改善诊断和治疗现状。方法：收集吉林大学第一医院神经肿瘤外科从2009年9月至2011年9月期间收治的PCNSL25例，对患者的年龄、性别、发病时间、影像学资料、手术治疗资料、病理学资料、患者转科后系统放化疗资料以及患者预后等情况进行回顾性分析总结。结果：本组25例病例中所有患者均无器官移植手术史、恶性肿瘤及自身免疫性疾病史，HIV抗体检查均阴性，其中男17例，女8例，男：女=2.1:1；发病年龄12~73（平均52.4）岁，其中50岁者18例（72%），，18岁者2例，两者占总患者人数80.0%。患者病程为6天~10个月，平均3个月。根据临床表现和核磁共振成像等影像学检查资料诊断为PCNSL。所有患者均行手术切除肿瘤（17例完全切除，8例部分切除）。组织病理学检查诊断：21例为弥漫性大B细胞性淋巴瘤（占84%），3例为小B细胞性淋巴瘤（占12%），1例为T淋巴细胞淋巴瘤（占4%）。5例患者(20.0%)接受全脑放射治疗，生存期为13~32个月，中位生存期为22个月；5例患者(20.0%)接受大剂量甲氨蝶呤化疗，生存期为17~40个月，中位生存期为25个月；7例患者(28.0%)接受大剂量甲氨蝶呤联合全脑放射治疗，生存时间为21~48个月，中位生存期为30个月；8例患者(32.0%)因病情较重或经济等原因手术后放弃放化疗，生存期最短，只有3~7个月，中位生存期仅4.5个月。结论： 1．本组25例PCNSL患者中男、女比例为2.1:1；发病平均年龄52.4岁，50岁以上患者18例（72%）；病程为6天~10个月。 2．核磁共振平扫加增强扫描是诊断PCNSL最有价值的检查方法。 3．手术切除肿瘤后，仅接受全脑放射治疗、单用大剂量甲氨蝶呤化疗和大剂量甲氨蝶呤联合全脑放射治疗，患者的中位生存期分别为22、25和30个月，术后未接受化疗和放疗者中位生存期仅4.5个月。 4．PCNSL患者的预后与治疗方案明显有关（P0.05）。手术切除肿瘤后采用大剂量甲氨蝶呤联合全脑放射治疗，能显著延长患者生存。
[Abstract]:Primary central nervous system lymphomatosis (PCNSLL) is a rare malignant tumor of the central nervous system. At present, the clinical diagnosis is still difficult and the therapeutic effect is not satisfactory.The main points of diagnosis and effective treatment have important clinical value.Objective: to analyze the clinical features and therapeutic effects of PCNSL in order to improve the diagnosis and treatment of the disease.Methods: PCNSL25 cases were collected from September 2009 to September 2011 in the Department of Neurooncology, the first Hospital of Jilin University. The age, sex, onset time, imaging data, surgical treatment and pathological data of the patients were analyzed.The data of systemic radiotherapy and chemotherapy and the prognosis of the patients were analyzed retrospectively.Results: all of the 25 cases had no history of organ transplantation, and all the patients were negative for HIV antibody in malignant tumor and autoimmune disease. Among them, 17 were male and 8 female, male: 2.1: 1; the age of onset was 1273 (mean 52.4) years.Among them, 18 cases were 50 years old and 2 cases were 18 years old, which accounted for 80. 0% of the total patients.The course of disease ranged from 6 days to 10 months with an average of 3 months.PCNSLs were diagnosed according to the clinical manifestations and MRI findings.All patients underwent surgical resection of tumor in 17 cases and partial resection in 8 cases.Histopathological examination showed that 21 cases of diffuse large B cell lymphoma (84%) were small B cell lymphoma (12 cases), and 1 case (20 0) of T lymphocyte lymphoma (4 cases) received whole brain radiotherapy. The survival time was 13 ~ 32 months.The median survival time was 30 months or 8 patients (32.0). The shortest survival time was 3 ~ 7 months, and the median survival time was 4.5 months.Conclusion:1.The male and female ratio of 25 PCNSL patients was 2.1: 1, the mean age of onset was 52.4 years old and over 50 years old, 18 cases were over 50 years old, the course of disease was from 6 days to 10 months.2.Plain MRI and enhanced MRI is the most valuable method for the diagnosis of PCNSL.3.After resection of tumor, only whole brain radiotherapy was accepted. The median survival time of the patients was 22 ~ 25 months and 30 months, respectively. The patients were treated with high dose methotrexate chemotherapy and high dose methotrexate combined with global brain radiotherapy.The median survival time of patients without chemotherapy or radiotherapy was 4.5 months.The prognosis of 4.PCNSL patients was significantly related to the treatment plan (P 0.05).High dose methotrexate combined with whole brain radiotherapy can significantly prolong survival after resection of tumor.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.4

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