中华皮肤科杂志 ›› 2012, Vol. 45 ›› Issue (7): 474-477.

• 论著 • 上一篇    下一篇

原发性皮肤B细胞淋巴瘤26例临床特点及预后分析

李雅妮王华庆1,邱立华1,2,钱正子1,2,张会来1,2,周世勇1,2,付凯2,3,郝希山2,4   

  1. 1. 天津医科大学附属肿瘤医院淋巴瘤科
    2.
    3. 天津医科大学附属肿瘤医院淋巴瘤科、中美淋巴血液肿瘤诊治中心
    4. 天津医科大学附属肿瘤医院
  • 收稿日期:2011-07-26 修回日期:2012-03-06 出版日期:2012-07-15 发布日期:2012-07-02
  • 通讯作者: 王华庆 E-mail:huaqingw@163.com

Clinical characteristics and prognosis of primary cutaneous B-cell lymphoma: 26 case reports

  • Received:2011-07-26 Revised:2012-03-06 Online:2012-07-15 Published:2012-07-02

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摘要：

目的 探讨原发性皮肤B细胞淋巴瘤（PCBCL）的高发年龄、临床特点、治疗方法及影响预后的因素。方法 1970年1月至2010年9月间天津市肿瘤登记中心共记录PCBCL 31例，其中26例临床资料完整。收集该26例患者的性别、年龄、首发部位、病变范围、病理类型、转移部位、治疗方法、生存期等资料并分析预后相关因素。数据采用SPSS 16.0统计软件包处理，生存分析采用Kaplan-Meier法，单因素预后分析采用Log-rank检验，多因素预后分析采用Cox比例风险模型，运用Forward LR法对变量进行筛选。结果 1970—2010年间资料完整的PCBCL 26例，临床表现不典型；病理类型以原发性皮肤滤泡中心淋巴瘤（12例）和原发性皮肤边缘带B细胞淋巴瘤（8例）最为常见，其次是原发性皮肤弥漫大B细胞淋巴瘤，腿型（4例）。随访显示，8例出现淋巴结受累，其中颈部4例，腹股沟4例；3例出现脏器受累，包括肺及胸膜1例、骨髓1例和中枢神经系统1例；多数患者经手术切除联合化疗或放化疗， 5年生存率为80.8%。统计分析显示，病理类型、乳酸脱氢酶、球蛋白与预后有关，而性别、年龄、首发部位、病变范围、内脏的受累、B症状、治疗方法、复发次数、β2微球蛋白、血红蛋白、淋巴细胞绝对值与预后无关。结论 PCBCL是一组罕见的结外淋巴瘤，高发年龄为39 ~ 66岁；临床表现不典型；5年生存率为80.8%；病理类型、乳酸脱氢酶、球蛋白与预后相关。

关键词: 预后

Abstract:

Objective To assess the predilection age, clinical features, treatment and prognostic factors of primary cutaneous B-cell lymphoma （PCBCL）. Methods A total of 31 patients with PCBCL were registered in Tianjin Cancer Central Registry from January 1970 to September 2010, and 26 patients had complete medical records. A retrospective analysis was conducted on the 26 patients. The following indices were analyzed, including gender, age, body sites of initial involvement, extent of cutaneous involvement, pathological subtypes, metastatic sites, treatment, survival and prognosis. Data were processed with SPSS16.0 software, survival analysis was carried out by using Kaplan-Meier method，univariate analysis of prognostic factors by Log-rank test, multivariate analysis of prognostic factors by COX proportional hazards model, and variables were selected by Forward LR method. Results Clinical manifestations were atypical in these patients. The ratio of man and women was 1 ∶ 1.6. Of the 26 cases, 12 were primary cutaneous follicle-center lymphoma （PCFCL）, 8 were primary cutaneous marginal zone lymaphoma （PCMZL）, and 4 were PCLBCL, leg type. Follow-up revealed lymph node involvement in 8 patients （4 in cervical nodes and 4 in inguinal nodes）, distant metastasis of organs in 3 patients（1 in lung and pleura, 1 in bone marrow and 1 in central nervous system）. Most patients received surgical treatment combined with chemotherapy or chemoradiation. The 5-year overall survival rate was 80.8% （21/26）. Statistical analysis showed that the prognosis of PCBCL was associated with histological subtype, lactate dehydrogenase （LDH） level and globulin level, but unrelated to gender, age, site of initial involvement, extent of cutaneous involvement, involvement of lymph nodes and organs, presence of B symptoms, treatment strategies, number of relapses, level of β2-globulin and hemoglobin, or lymphocyte absolute value. Conclusions PCBCL, as a kind of rare extra-nodal lymphoma, usually occurs with atypical clinical mainfestations in persons aged from 39 to 66 years. The 5-year overall survival rate was 80.8% in these patients. The prognosis of PCBCL seems to be related to histological subtypes, LDH and globulin levels.

Key words: Prognosis