124例原发胃恶性淋巴瘤患者的临床特征及预后分析

OBJECTIVE: To analyze the clinical characteristics, treatment and prognosis of primary gastric lymphomas (PGL). METHODS: A retrospective study was conducted in 124 cases of PGL from July 2009 to January 2016 in our hospital, and the clinical records, pathological and immunohistochemical features were analyzed. The relationship between different factors at diagnosis and prognosis were studied. RESULTS: 124 cases of PGL included 93 diffuse large B cell lymphoma (DLBCL) patients, 25 mucosa associated lymphoid tissue (MALT) lymphoma cases, 1 mantle cell lymphoma, 4 peripheral T-cell lymphoma-not otherwise specified, and 1 extra-nodal NK/T-cell lymphoma-nasal type. Of the 93 primary gastric DLBCL (PG-DLBCL) patients, the germinal center B cell-like (GCB) DLBCL were 45 cases, non-GCB DLBCL were 48 cases. 10 cases (10.8%) of 93 PG-DLBCL were transformed from gastric MALT, and 7 cases (7.5%) have bone marrow involvement. Evidence of Helicobacter pylori infection was detected in 21 cases (51.2%) of 41 DLBCL patients and in 10 cases (43.5%) of 23 MALT patients. Univariate analysis revealed that clinical stages (P=0.002), B symptoms (P=0.001), international prognostic index (IPI) score (P<0.001), anemia (P<0.001), low level of serum albumin level (P=0.001), high level of lactate dehydrogenase (LDH) (P<0.001), high β2-microglobulin (P=0.003), chemotherapy uncombined with rituximab (P=0.006) were factors affecting progression-free survival (PFS). Multivariate Cox regression analysis indicated that clinical stages (HR=5.113, 95% CI 1.087–24.048, P=0.039) and LDH (HR=5.111, 95%CI 1.651–15.827, P=0.005) were independent poor prognosis factors affecting PFS. In the non-GCB group, the PFS was significantly extended (P=0.013), the OS has no statistical significance (P=0.764). The PFS was significantly shortened in MALT transformed to DLBCL compared with MALT lymphoma patients (P=0.016), but have no statistical significance compared with DLBCL patients (P=0.373). CONCLUSION: The types of DLBCL and MALT are more common in PGL. PG-DLBCL is a highly heterogeneous malignant tumor, and advanced clinical stages and high LDH value are associated with poor outcome.