37例原发骨恶性淋巴瘤的临床特点及预后因素分析

探讨原发骨恶性淋巴瘤（primary bone lymphoma，PBL）的临床特点及其与预后的相关性。方法:回顾性分析1995年6月至2009年5月本院收治的37例PTL患者的临床资料，以Kaplan-Meier法绘制生存曲线，用Log-rank检验进行单因素分析，多因素分析采用Cox回归模型以评估独立的预后因素。结果:37例患者的中位发病年龄为61（18～85）岁，首发症状主要表现为骨痛，局部软组织肿胀、肿块形成和病理性骨折。78%患者的病理类型为弥漫大B细胞淋巴瘤。经化疗和/或放疗，18例完全缓解（complete response，CR），13例部分缓解（partial response，PR），3例稳定（stable disease，SD），2例进展（progressive disease，PD）。中位随访时间32（7～171）个月，5年和10年总生存率分别为59.5%和43.2%。患者接受4周期以上化疗，B细胞淋巴瘤加用利妥昔单抗者疗效较好。多因素分析显示:Ann Arbor分期、B症状、年龄和结外受侵数是PBL的独立预后因素。结论:PBL应采取综合治疗，同时给予蒽环类药物为主的全身化疗，B细胞淋巴瘤首选利妥昔单抗联合化疗，给予帕米膦酸盐治疗骨病变。Ann Arbor分期、B症状、年龄和结外受侵数为PBL预后的独立影响因素。 

Clinical Characteristics and Prognostic Analysis of Primary Malignant Bone Lymphoma

To investigate the clinical features and prognostic factors of primary bone lymphoma ( PBL ). Methods: A retrospective analysis was performed based on the clinical records of 37 PBL cases treated at the Tianjin Medical University Cancer Hospital between June 1995 and May 2009. Survival curves were plotted using the Kaplan-Meier method, with the Log-rank COX regression model to evaluate the independent prognostic factors. Results: The median age of patients was 61 years ( range 18-85 years ). Ostealgia was the initial symptom. The majority of cases presented with diffuse large B-cell non-Hodgkin's lymphoma. Through chemotherapy and/or radiotherapy, 18 patients achieved complete remission ( CR ) and 13 achieved partial remission ( PR ), with a median follow-up of 32 months ( 7-171 months ). The 5- and 10-year overall survival rates were 59.5% and 43.2%, respectively. The patients treated with chemotherapy ≥4 cycles combined with rituximab for B cell lymphoma achieved better outcomes. In the multivariate analysis, the Ann Arbor stage, B symptoms, ages, and the number of extranodal involvement sites were independent prognostic factors. Conclusion: Primary bone non-Hodgkin's lymphoma should be treated with a multi-modality strategy. Treatment with more than 4 cycles of doxorubicin-based chemotherapy after orchiectomy is recommended. For B cell lymphoma, rituximab plus chemotherapy is preferred. Pamidronate disodium is necessary. The Ann Arbor stage, B symptom, age, and number of extranodal sites are independent prognostic factors of PBL.