胃肠道原发与继发非霍奇金淋巴瘤临床及内镜特点的差异
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摘要
目的比较胃肠道原发与继发非霍奇金淋巴瘤(non-Hodgkin’s lymphomas,NHLs)临床与内镜特点的差异。方法检索2010年5月～2017年5月我院住院患者病历资料。纳入标准:内镜及病理诊断确诊为胃肠道非霍奇金淋巴瘤。排除标准:临床、内镜资料不完整,没有进行系统的临床评估,无法确定是否为原发或继发胃肠道非霍奇金淋巴瘤。共纳入130例,其中原发组65例(男36例),(58. 3±13. 8)岁,继发组65例(男37例),(60. 4±15. 9)岁。比较人口统计学资料、受累部位、临床及内镜表现、病理类型、幽门螺杆菌(Helicobacter pylori)感染情况等指标。结果临床表现上,原发组27例(41. 5%)存在B组症状,继发组为39例(60. 0%)(χ~2=4. 432,P=0. 035)。病理类型上,2组最常见的均为弥漫大B细胞淋巴瘤,但黏膜相关淋巴组织(mucosa associated lymphoid tissue,MALT)淋巴瘤在原发组(20例,30. 8%)明显高于继发组(2例,3. 1%)(χ~2=17. 727,P=0. 000)。受累部位上,继发组结直肠受累(14例,21. 5%)明显多于原发组(4例,6. 2%)(χ~2=6. 448,P=0. 011)。内镜下表现,2组胃部受累最常见表现均为溃疡型病变,而肠道受累最常见表现均为肿块型病变,2组无显著差异。原发组幽门螺杆菌阳性率为51. 2%(21/41),继发组为30. 4%(7/23),2组间无显著差异(χ~2=2. 587,P=0. 108)。但在弥漫大B细胞淋巴瘤中,原发组幽门螺杆菌阳性率(59. 1%,13/22)明显高于继发组(27. 3%,6/22)(χ~2=4. 539,P=0. 033)。结论与胃肠道原发非霍奇金淋巴瘤相比,继发非霍奇金淋巴瘤B组症状更常见,结直肠受累更常见,MALT淋巴瘤少见,幽门螺杆菌感染率低。
Objective To compare clinical and endoscopic characteristics of primary and secondary gastrointestinal nonHodgkin's lymphomas( NHLs). Methods Medical records of hospitalized patients in our hospital from May 2010 to May 2017 were collected. Inclusion criteria: patients diagnosed with gastrointestinal NHLs through endoscopic and pathological diagnosis. Exclusion criteria: incomplete clinical and endoscopic data, no systematic clinical evaluation and patients which primary or secondary gastrointestinal NHLs could not be determined. A total of 130 patients with gastrointestinal NHLs were enrolled,including 65 patients( 36 males) in the primary group with an average age of( 58. 3 ± 13. 8) years old,and 65 patients( 37 males) in the secondary group with an average age of( 60. 4 ± 15. 9) years old. Demographic data,involvement location,clinical and endoscopic manifestations,pathological types,Helicobacter pylori( H. Pylori) infection and other indicators were compared. Results Clinically,27 patients( 41. 5%) in the primary group had group B symptoms and 39 patients( 60. 0%) in the secondary group had group B symptoms( χ~2=4. 432,P = 0. 035). Pathologically,diffuse large B-cell lymphoma was the most common in both groups,but mucosa associated lymphoid tissue( MALT) lymphoma was significantly higher in the primary group( 20 cases,30. 8%) than in the secondary group( 2 cases,3. 1%)( χ~2= 17. 727,P = 0. 000). As for involvement location,colorectal involvement in the secondary group( 14 cases,21. 5%) was significantly more than the primary group( 4 cases,6. 2%)( χ~2= 6. 448,P = 0. 011). The most common endoscopic manifestations of gastric involvement in both groups were ulcerative lesions,while the most common endoscopic manifestations of intestinal involvement were elevated lesions,with no significant difference between the two groups. The positive rate of H. pylori was51. 2%( 21/41) in the primary group and 30. 4%( 7/23) in the secondary group,but there was no significant difference between the two groups( χ~2= 2. 587,P = 0. 108). However,in diffuse large B-cell lymphoma,the H. pylori infection rate in the primary group( 59. 1%,13/22) was significantly higher than that in the secondary group( 27. 3%,6/22)( χ~2= 4. 539,P = 0. 033). Conclusions Compared with primary gastrointestinal NHLs,secondary gastrointestinal NHLs is more common having group B symptoms and colorectal involvement. MALT lymphoma is rare and H. pylori infection rate is lower than that of primary gastrointestinal lymphoma.
Objective To compare clinical and endoscopic characteristics of primary and secondary gastrointestinal nonHodgkin's lymphomas( NHLs). Methods Medical records of hospitalized patients in our hospital from May 2010 to May 2017 were collected. Inclusion criteria: patients diagnosed with gastrointestinal NHLs through endoscopic and pathological diagnosis. Exclusion criteria: incomplete clinical and endoscopic data, no systematic clinical evaluation and patients which primary or secondary gastrointestinal NHLs could not be determined. A total of 130 patients with gastrointestinal NHLs were enrolled,including 65 patients( 36 males) in the primary group with an average age of( 58. 3 ± 13. 8) years old,and 65 patients( 37 males) in the secondary group with an average age of( 60. 4 ± 15. 9) years old. Demographic data,involvement location,clinical and endoscopic manifestations,pathological types,Helicobacter pylori( H. Pylori) infection and other indicators were compared. Results Clinically,27 patients( 41. 5%) in the primary group had group B symptoms and 39 patients( 60. 0%) in the secondary group had group B symptoms( χ~2=4. 432,P = 0. 035). Pathologically,diffuse large B-cell lymphoma was the most common in both groups,but mucosa associated lymphoid tissue( MALT) lymphoma was significantly higher in the primary group( 20 cases,30. 8%) than in the secondary group( 2 cases,3. 1%)( χ~2= 17. 727,P = 0. 000). As for involvement location,colorectal involvement in the secondary group( 14 cases,21. 5%) was significantly more than the primary group( 4 cases,6. 2%)( χ~2= 6. 448,P = 0. 011). The most common endoscopic manifestations of gastric involvement in both groups were ulcerative lesions,while the most common endoscopic manifestations of intestinal involvement were elevated lesions,with no significant difference between the two groups. The positive rate of H. pylori was51. 2%( 21/41) in the primary group and 30. 4%( 7/23) in the secondary group,but there was no significant difference between the two groups( χ~2= 2. 587,P = 0. 108). However,in diffuse large B-cell lymphoma,the H. pylori infection rate in the primary group( 59. 1%,13/22) was significantly higher than that in the secondary group( 27. 3%,6/22)( χ~2= 4. 539,P = 0. 033). Conclusions Compared with primary gastrointestinal NHLs,secondary gastrointestinal NHLs is more common having group B symptoms and colorectal involvement. MALT lymphoma is rare and H. pylori infection rate is lower than that of primary gastrointestinal lymphoma.
引文
1 Bautista-Quach MA,Ake CD,Chen M,et al. Gastrointestinal lymphomas:morphology,immunophenotype and molecular features. J Gastrointest Oncol,2012,3(3):209-225.
2 Ruskoné-Fourmestraux A,Fischbach W,Aleman BM,et al. EGILS consensus report. Gastric extranodal marginal zone B-cell lymphoma of MALT. Gut,2011,60(6):747-758.
3 Zucca E,Copie-Bergman C,Ricardi U,et al. Gastric marginal zone lymphoma of MALT type:ESMO Clinical Practice Guidelines for diagnosis,treatment and follow-up. Ann Oncol,2013,24 Suppl 6:vi144-148.
4 Matysiak-Budnik T,Fabiani B,Hennequin C,et al. Gastrointestinal lymphomas:French Intergroup clinical practice recommendations for diagnosis,treatment and follow-up(SNFGE,FFCD, GERCOR,UNICANCER,SFCD,SFED,SFRO,SFH). Dig Liver Dis,2018,50(2):124-131.
5 Dawson IM,Cornes JS,Morson BC. Primary malignant lymphoid tumours of the intestinal tract. Report of 37 cases with a study of factors influencing prognosis. Br J Surg,1961,49:80-89.
6 Swerdlow SH,Campo E,Pileri SA,et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms.Blood,2016,127(20):2375-2390.
7 Rohatiner A,d’Amore F,Coiffier B,et al. Report on a workshop convened to discuss the pathological and staging classifications of gastrointestinal tract lymphoma. Ann Oncol,1994,5(5):397-400.
8 Kolve M,Fischbach W,Greiner A,et al. Differences in endoscopic and clinicopathological features of primary and secondary gastric non-Hodgkin’s lymphoma. German Gastrointestinal Lymphoma Study Group. Gastrointest Endosc,1999,49(3 Pt 1):307-315.
9 Chen Y,Chen Y,Chen S,et al. Primary gastrointestinal lymphoma:a retrospective multicenter clinical study of 415 cases in Chinese province of Guangdong and a systematic review containing 5075Chinese patients. Medicine(Baltimore),2015,94(47):e2119.
10 Lightner AL,Shannon E,Gibbons MM,et al. Primary gastrointestinal non-Hodgkin’s lymphoma of the small and large intestines:a systematic review. J Gastrointest Surg,2016,20(4):827-839.
11 Juárez-Salcedo LM,Sokol L,Chavez JC,et al. Primary gastric lymphoma,epidemiology,clinical diagnosis,and treatment. Cancer Control,2018,25(1):1073274818778256.
12 Koch P,del Valle F,Berdel WE,et al. Primary gastrointestinal nonHodgkin’s lymphoma:I. Anatomic and histologic distribution,clinical features,and survival data of 371 patients registered in the German Multicenter Study GIT NHL 01/92. J Clin Oncol,2001,19(18):3861-3873.
13 Kuo SH,Yeh KH,Wu MS,et al. Helicobacter pylori eradication therapy is effective in the treatment of early-stage H pylori-positive gastric diffuse large B-cell lymphomas. Blood,2012,119(21):4838-4844.
14 张宏娜,丁士刚,王晔.胃肠道淋巴瘤临床研究进展.中国微创外科杂志,2018,18(5):450-453.
15 刘高双,王宇晴,李培培,等.原发于胃肠道的黏膜相关淋巴组织淋巴瘤及弥漫性大B细胞淋巴瘤临床表现及内镜特征的比较.南京医科大学学报(自然科学版),2018,38(1):67-71.
2 Ruskoné-Fourmestraux A,Fischbach W,Aleman BM,et al. EGILS consensus report. Gastric extranodal marginal zone B-cell lymphoma of MALT. Gut,2011,60(6):747-758.
3 Zucca E,Copie-Bergman C,Ricardi U,et al. Gastric marginal zone lymphoma of MALT type:ESMO Clinical Practice Guidelines for diagnosis,treatment and follow-up. Ann Oncol,2013,24 Suppl 6:vi144-148.
4 Matysiak-Budnik T,Fabiani B,Hennequin C,et al. Gastrointestinal lymphomas:French Intergroup clinical practice recommendations for diagnosis,treatment and follow-up(SNFGE,FFCD, GERCOR,UNICANCER,SFCD,SFED,SFRO,SFH). Dig Liver Dis,2018,50(2):124-131.
5 Dawson IM,Cornes JS,Morson BC. Primary malignant lymphoid tumours of the intestinal tract. Report of 37 cases with a study of factors influencing prognosis. Br J Surg,1961,49:80-89.
6 Swerdlow SH,Campo E,Pileri SA,et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms.Blood,2016,127(20):2375-2390.
7 Rohatiner A,d’Amore F,Coiffier B,et al. Report on a workshop convened to discuss the pathological and staging classifications of gastrointestinal tract lymphoma. Ann Oncol,1994,5(5):397-400.
8 Kolve M,Fischbach W,Greiner A,et al. Differences in endoscopic and clinicopathological features of primary and secondary gastric non-Hodgkin’s lymphoma. German Gastrointestinal Lymphoma Study Group. Gastrointest Endosc,1999,49(3 Pt 1):307-315.
9 Chen Y,Chen Y,Chen S,et al. Primary gastrointestinal lymphoma:a retrospective multicenter clinical study of 415 cases in Chinese province of Guangdong and a systematic review containing 5075Chinese patients. Medicine(Baltimore),2015,94(47):e2119.
10 Lightner AL,Shannon E,Gibbons MM,et al. Primary gastrointestinal non-Hodgkin’s lymphoma of the small and large intestines:a systematic review. J Gastrointest Surg,2016,20(4):827-839.
11 Juárez-Salcedo LM,Sokol L,Chavez JC,et al. Primary gastric lymphoma,epidemiology,clinical diagnosis,and treatment. Cancer Control,2018,25(1):1073274818778256.
12 Koch P,del Valle F,Berdel WE,et al. Primary gastrointestinal nonHodgkin’s lymphoma:I. Anatomic and histologic distribution,clinical features,and survival data of 371 patients registered in the German Multicenter Study GIT NHL 01/92. J Clin Oncol,2001,19(18):3861-3873.
13 Kuo SH,Yeh KH,Wu MS,et al. Helicobacter pylori eradication therapy is effective in the treatment of early-stage H pylori-positive gastric diffuse large B-cell lymphomas. Blood,2012,119(21):4838-4844.
14 张宏娜,丁士刚,王晔.胃肠道淋巴瘤临床研究进展.中国微创外科杂志,2018,18(5):450-453.
15 刘高双,王宇晴,李培培,等.原发于胃肠道的黏膜相关淋巴组织淋巴瘤及弥漫性大B细胞淋巴瘤临床表现及内镜特征的比较.南京医科大学学报(自然科学版),2018,38(1):67-71.
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