黏膜相关淋巴组织结外边缘区B细胞淋巴瘤预后相关因素分析

 【摘要】　目的　分析黏膜相关淋巴组织结外边缘区B细胞淋巴瘤（MALT 淋巴瘤）的临床病理学特点，并探讨其预后相关指标。方法　选取86例MALT淋巴瘤患者，依据肿瘤发生部位分为胃MALT淋巴瘤组（32例）和非胃MALT淋巴瘤组（54例）。常规HE染色、免疫组织化学（EnVision二步法）观察其病理学特点，采用间期荧光原位杂交（FISH）方法对部分病例检测肿瘤特征性的分子遗传学改变，并对病例进行临床随访。结果　两组病例临床病理学特点无明显差异。间期FISH检测结果显示t(11;18)和t(14;18)发生率分别为12 %（6／50）和9 %（4／45）。胃MALT淋巴瘤组中20例获得随访，均接受单纯抗幽门螺杆菌治疗，bcl-10核表达阳性、存在t(11;18)病例的缓解率（20 %、33 %）显著低于阴性组（73 %、91 %），差异均有统计学意义（χ2＝3.842，P＝0.035；χ2＝4.639，P＝0.031）。非胃MALT淋巴瘤组病例中35例获得随访，女性、年龄≤60岁患者的缓解率（60 %、63 %）显著高于男性、＞60岁患者（35 %、25 %），差异均有统计学意义（χ2＝3.905，P＝0.048；χ2＝7.373，P＝0.007）；临床Ⅰ～Ⅱ期、t（14；18）患者的无进展生存（PFS）率（52 %、75 %）显著高于Ⅲ～Ⅳ期、t（14；18）阴性者（25 %、50 %），差异均有统计学意义（χ2＝4.207，P＝0.040；χ2＝4.363，P＝0.037）。结论　MALT淋巴瘤是一类好发于中老年人的惰性淋巴瘤，预后较好，胃与非胃MALT淋巴瘤存在不同的治疗反应评估或预后预测指标。

Analysis of prognostic factors of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue

Objective To study the clinicopathologic features and explore the potential prognostic factors of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue （MALT lymphoma）. Methods 86 patients diagnosed with MALT lymphoma were retrieved and divided into 2 subgroups according to the location of tumor, namely gastric （32 cases） and non-gastric （54 cases） subgroup. Histological characteristics were reassessed on hematoxylin-eosin staining slides, and immunophenotypic features were determined by immunohistochemical staining. Interphase fluorescence in-situ hybridization （FISH） was carried out to detect the cytogenetic abnormalities. Results There were no significant difference of clinical behavior, histology, and immunophenotype between gastric and non-gastric subgroups. In addition, FISH detected t（14;18） in 9 % （4/45） and t（11;18） in 12 % cases （6/50） respectively. Among the 20 cases treated with H pylori （HP） eradication, a significantly lower remission rate was observed in cases with bcl-10 （20 %） nuclear expression or those harboring t（ll;18） （33 %） compared with those in the negative group （73 %, 91%） （X2 = 3.842 and 4.639, P = 0.035 and 0.031, respectively）. For the 35 non-gastric patients with follow-up data, males （35 %） and patients older than 60 yrs （25 %） tended to have a lower remission rate as compared to females （60 %） and those younger than 60 yrs （63 %） （X2 =3.905 and 7.373, P = 0.048 and 0.007, respectively）. Moreover, progression-free survival rate was significantly lower in patients with higher stage （III- IV） （25 %） and without t（14;18） （50 %） than that in patients with stage I - II （52 %） and with t（14;18） （75 %）. The differences had statistical significance （X2 = 4.207 and 4.363, P = 0.040 and 0.037, respectively）. Conclusion MALT lymphoma in general is an indolent B-cell non-Hodgkin＇s lymphoma which more frequently occurs in the elderly people. Differences in the response to treatment or the prognosis are observed between gastric and non-gastric MALT lymphoma patients.