上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2019, Vol. 39 ›› Issue (9): 1032-.doi: 10.3969/j.issn.1674-8115.2019.09.015

• 论著·临床研究 • 上一篇    下一篇

肾上腺淋巴瘤临床病理特点及预后因素分析

姜涛 1, 2，施晴 1，许彭鹏 1，程澍 1，王黎 1，赵维莅 1   

  1. 1. 上海交通大学医学院附属瑞金医院血液科，医学基因组学国家重点实验室，上海血液学研究所，上海 200025；2. 四川省医学科学院 .四川省人民医院血液科，成都 610072
  • 出版日期:2019-09-28 发布日期:2019-11-02
  • 通讯作者: 王黎，电子信箱：wl_wangdong@126.com。
  • 作者简介:姜涛（1978—），男，主治医师，博士；电子信箱： suyeku@126.com。
  • 基金资助:
    国家自然科学基金（81520108003，81670716，81830007）；上海市科学技术委员会课题（16JC1450800）；上海市杰出青年医学人才培养资助计划；上海市教育委员会高峰高原学科建设计划（20152206，20152208）；上海市人才基金

Clinicopathology and prognosis analysis of adrenal lymphoma

JIANG Tao1, 2, SHI Qing1, XU Peng-peng1, CHENG Shu1, WANG Li1, ZHAO Wei-li1   

  1. 1. Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine; State Key Laboratory of Medical Genomics; Shanghai Institute of Hematology, Shanghai 200025, China; 2. Department of Hematology, Sichuan Academy of Medical Science & Sichuan Provincial Peoples Hospital, Chengdu 610072, China
  • Online:2019-09-28 Published:2019-11-02
  • Supported by:
    National Natural Science Foundation of China, 81520108003, 81670716, 81830007; Project of Shanghai Municipal Science and Technology Committee, 16JC1450800; Training Program for Excellent Young Medical Talent in Shanghai; Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Support, 20152206, 20152208; Shanghai Talent Development Fund）。

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摘要： 目的 ·探讨肾上腺淋巴瘤患者的临床表现、病理特征及预后因素。方法 ·回顾性分析上海交通大学医学院附属瑞金医院血液科 2002年 1月—2018年 6月 77例经肾上腺病理检查确诊或有影像学证据证明肿瘤累及肾上腺的非霍奇金淋巴瘤患者的临床及病理资料，比较原发性肾上腺淋巴瘤（ primary adrenal lymphoma，PAL）和继发性肾上腺淋巴瘤（ secondary adrenal lymphoma，SAL）患者的临床特点，采用 Kaplan-Meier法进行生存分析， Cox回归模型分析影响预后的因素。结果 · 77例患者中 PAL 28例，SAL 49例；病理类型以弥漫大 B细胞淋巴瘤为主，占 77.9%；伴有骨骼和胃肠道受累的患者各 21例。PAL双侧累及（ 67.9%）和巨大包块（67.9%）的比例较高； SAL以Ⅲ / Ⅳ期（95.9%）较多，伴胰腺（ 24.5%）和骨骼（ 38.8%）累及较多。与 B细胞来源淋巴瘤和治疗达到完全缓解的患者相比， T/NK细胞来源淋巴瘤和治疗未达完全缓解的患者生存时间显著较短（ P0.005，P0.000）。结论 ·肾上腺淋巴瘤临床表现缺乏特异性，病理类型以弥漫大 B细胞淋巴瘤为主， PAL多见双侧同时受累和巨大包块， SAL多为晚期，同时伴有其他部位受累。T/NK细胞来源和治疗未达到完全缓解是主要的不良预后因素。

关键词: 肾上腺淋巴瘤, 临床特征, 病理类型, 预后

Abstract:

Objective · To investigate the clinical manifestations, pathological features and prognostic factors of patients with adrenal lymphoma. Methods · A retrospective analysis was made with the clinical and pathological data of 77 patients with adrenal non-Hodgkins lymphoma confirmedpathology or confirmedimaging evidence in the Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine January 2002 to June 2018. The clinical characteristics of primary adrenal lymphoma (PAL) and secondary adrenal lymphoma (SAL) were compared. Kaplan-Meier curve was used for survival analysis, and Cox regression model was used to analyze the prognostic factors. Results · Of the 77 patients, 28 were PAL and 49 were SAL. The predominant pathological type was difflarge B-cell lymphoma, accounting for 77.9%. There were 21 patients accompaniedbone and gastrointestinal involvement, respectively. The proportions of bilateral involvement (67.9%) and large mass (67.9%) were higher in the PAL patients, while the proportions of Ⅲ / Ⅳ stage (95.9%) and pancreas (24.5%) and bone (38.8%) involvement were higher in the SAL patients. The patients with T/ NK cell-derived lymphoma or with incomplete remission after treatment had significantly shorter survival time than those with B cell-derived lymphoma or with complete remission after treatment (P0.005, P0.000). Conclusion · The clinical manifestations of adrenal lymphoma lack specificity. The main pathological type is difflarge B-cell lymphoma. Bilateral involvement and large mass are more common in PAL, while advanced disease and pancreas and bone involvement are more common in SAL. T/NK cell-derived lymphoma and incomplete remission after treatment are major adverse prognostic factors.

Key words: adrenal lymphoma, clinical feature, pathological type, prognosis

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