临床儿科杂志 ›› 2015, Vol. 33 ›› Issue (8): 715-.doi: 10.3969 j.issn.1000-3606.2015.08.009

• 综合报道 • 上一篇    下一篇

儿童非霍奇金淋巴瘤78 例临床及预后分析

姜健 1,宋学文 2,徐慧娟 1,仲任 1,泥永安 1,孙立荣1   

  1. 1. 青岛大学附属医院( 山东青岛 266003 );2. 济南军区青岛第一疗养院(山东青岛 266071 )
  • 收稿日期:2015-08-15 出版日期:2015-08-15 发布日期:2015-08-15
  • 通讯作者: 宋学文 E-mail:tssotalol@163.com

Clinical features and outcomes of 78 children with non-Hodgkin lymphoma

 JIANG Jian 1, SONG Xuewen 2, XU Huijuan 1, ZHONG Ren 1, NI Yongan 1, SUN Lirong 1   

  1. The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong, China
  • Received:2015-08-15 Online:2015-08-15 Published:2015-08-15

摘要:  目的 探讨儿童非霍奇金淋巴瘤(NHL)临床表现及影响预后的因素。方法 收集2004年1月至2013年8月期间确诊的78例NHL患儿的资料,采用Kaplan-Meier方法计算5年无事件生存率(EFS),用Cox比例风险模型分析年龄、性别、肿瘤大小、免疫分型、B症状、乳酸脱氢酶(LDH)、临床分期等因素对5年EFS的影响。结果 78例NHL的中位发病年龄是7岁,男女比例2.90∶1。其中T细胞型25例,B细胞性53例,病理类型以Burkitt淋巴瘤最常见。根据St.Jude淋巴瘤分期,Ⅰ期2例,Ⅱ期9例,Ⅲ期35例,Ⅳ期32例。26例淋巴母细胞淋巴瘤主要以外周淋巴结肿大(80.7%)为首发表现,27例Burkitt淋巴瘤患儿主要以腹腔和口腔牙龈受累。73例患儿进行治疗,化疗2个疗程后,完全缓解66例(90.5%),部分缓解4例(5.5%),2例(2.7%)在1个疗程缓解后复发,1例(1.3%)在化疗中出现中枢神经系统浸润。中位随访时间42个月,73例患儿的5年EFS为(67.0±5.5)%。单因素分析显示,B症状、LDH水平、临床分期与患儿预后显著相关(P<0.05),而年龄、性别、肿块大小等与预后无关(P>0.05),多因素分析显示,LDH水平、临床分期影响患儿预后(OR=3.34,95% CI 2.275~10.683,P<0.01;OR=4.354,95% CI 1.519~12.475,P<0.01)。结论 儿童NHL临床表现多样化,初诊时LDH水平、临床分期是影响预后的重要因素。

Abstract: Objective To explore the clinical features and factors influencing the prognosis of childhood non-Hodgkin's lymphoma (NHL). Methods Pathologically diagnosed 78 pediatric patients with NHL and treated in the Affiliated Hospital of Qingdao University from January 2004 to August 2013 were collected and analyzed. Patients were grouped according to age, sex, tumor size, immunologic classification, B-symptoms, LDH, hemoglobin and clinical staging. The 5-years event-free survival rate (EFS) were calculated and analyzed by Kaplan-Meier method, and the difference of the survival rate between groups were compared. Using Cox proportional hazards model, we analyzed the possible factors that might influence 5-years event-free survival rate EFS , such as age and clinical staging. The OR value and the 95% CI were calculated. Results Among the 78 cases, median age of onset is 7 years old, male to female ratio is 2.90:1, there are 25 cases of T-cell type and 53 cases of B-cell type. According to pathological types,Burkitt lymphoma is the most common (34.6%), followed by T-lymphoblastic lymphoma (20.5%), diffuse large B-cell lymphoma (11.5%). According to the St. Jude malignant lymphoma staging system, there are 2 cases in stage I, 9 in stage Ⅱ , 35 in stage Ⅲ and 32 in stage Ⅳ. Swelling of periphery lymph node (80.7%) was observed as initial symptom in 26 cases of lymphoblastic lymphoma. Among 45 cases of mature B-cell tumor, the main clinical feature including abdominal cavity and gingival were observed in 27 cases of Burkitt lymphoma. Among the 73 cases received treatments, 66 cases (90.5%) attained CR (complete remission) and 4 cases (5.5%) attained PR (partial remission) by cytology and radiographic assessment after two course of combined chemotherapy, 2 cases (2.7%) rapidly relapsed after the remisson of one course treatment, 1 case (1.3%) appeared the central nervous system infiltration in the chemotherapy. With median follow-up time of 42 months, the 5-year EFS of the 73 cases was (67.0+5.5)%. Single factor analysis showed that B-symptom, LDH, and clinical staging were significantly correlated with prognosis (P<0.05), while age, sex, tumor size, hemoglobin and immune classification was independent of prognosis (P>0.05). Multiple factor analysis showed that LDH and clinical staging influenced the prognosis (OR=3.34,95 % CI 2.275−10.683,P<0.01;OR=4.354,95%CI 1.519−12.475,P<0.01) . Conclusion clinical features of childhood NHL are variable. LDH and clinical staging at primary diagnosis are important factors affecting the prognosis.