43例乳腺原发性淋巴瘤患者临床病理特征及预后分析

发布时间：2018-10-12 14:13

【摘要】：目的探讨乳腺原发性淋巴瘤(PBL)患者临床病理特征及预后影响因素。方法回顾性分析43例PBL患者的临床资料,总结PBL患者的临床病理特征及预后影响因素。结果全组43例患者均为女性,中位年龄50岁,首发症状多为无痛性肿物,肿物多位于乳腺外上象限(58.1%)。术前乳腺B超及钼靶难与良性肿瘤区分,乳腺粗针穿刺及快速冰冻病理诊断率亦不高。手术后病理诊断弥漫大B细胞淋巴瘤(DLBCL)30例,淋巴母细胞型淋巴瘤2例,黏膜相关淋巴组织型结节外边缘区B细胞淋巴瘤(MALT淋巴瘤)、滤泡性淋巴瘤、淋巴浆细胞淋巴瘤、小淋巴细胞淋巴瘤各1例。43例患者中38例行手术加化疗,9例行术后放疗,化疗方案以CHOP为主。中位随访时间33个月,5年总生存率和无病生存率分别为42%和20%。年龄、临床分期、国际预后指数(IPI)为总生存的独立预后因素(P均0.01);而临床分期(P=0.03)、IPI(P=0.01)、放疗(P=0.02)为无病生存的独立预后因素。骨髓为最常见转移部位,其次为同侧及对侧乳腺。结论 PBL以DLBCL多见,预后差,复发转移早,影像学检查缺乏特异性,手术仅能明确诊断;应采取以化疗、放疗为主的综合方案治疗。
[Abstract]:Objective to investigate the clinicopathological features and prognostic factors of primary breast lymphoma (PBL). Methods the clinical data of 43 patients with PBL were analyzed retrospectively. The clinicopathological features and prognostic factors of PBL were summarized. Results all 43 patients were female with median age of 50 years. Most of the initial symptoms were painless masses, most of which were located in the superior quadrant of the mammary gland (58.1%). It is difficult to distinguish benign tumors from benign breast by B-ultrasound and mammography before operation, and the diagnostic rate of coarse needle puncture and rapid freezing pathology is not high. 30 cases of diffuse large B cell lymphoma (DLBCL), 2 cases of lymphoblastoid lymphoma, 2 cases of MALT lymphoma, follicular lymphoma, lymphoplasmacyte lymphoma were diagnosed by pathology after operation. In 43 cases, 38 cases were treated with operation plus chemotherapy, 9 cases with postoperative radiotherapy. CHOP was the main chemotherapy regimen. The median follow-up time was 33 months. The 5-year overall survival rate and disease-free survival rate were 42% and 20%, respectively. Age, clinical stage and international prognostic index (IPI) were independent prognostic factors of total survival (P0. 01), while clinical stage (P0. 03), IPI (P0. 01) and radiotherapy (P0. 02) were independent prognostic factors of disease-free survival. Bone marrow was the most common metastatic site, followed by ipsilateral and contralateral mammary glands. Conclusion DLBCL is more common in PBL with poor prognosis, early recurrence and metastasis, lack of specificity in imaging examination, and only definite diagnosis after operation, and should be treated with chemotherapy and radiotherapy.
【作者单位】：天津医科大学肿瘤医院国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室乳腺癌防治教育部重点实验室;
【分类号】：R737.9

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