黏膜相关淋巴组织国际预后指数对中国人群黏膜相关淋巴组织淋巴瘤预后的评估价值
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摘要
目的:探讨黏膜相关淋巴组织(MALT)国际预后指数(IPI)在中国人群MALT淋巴瘤患者中的适用性,并比较不同风险分层方法对MALT淋巴瘤的预后评估价值。方法:回顾2007年1月至2016年12月129例MALT淋巴瘤患者的临床资料,采用Kaplan-Meier法和log-rank法计算并比较MALT-IPI与IPI不同分层分组患者的总体生存率(OS)和无进展生存率(PFS)。结果:129例患者中位发病年龄56岁(22~82岁),其中胃MALT淋巴瘤53例(41.1%),肺MALT淋巴瘤33例(25.6%);Ann ArborⅠ~Ⅱ期71例(55.1%),Ⅲ~Ⅳ期58例(44.9%)。中位随访时间26个月(1~378个月)。总体5年PFS为69.41%,5年OS为90.23%。IPI评分低危、中低危和中高危/高危组患者5年OS、PFS差异无统计学意义;MALT-IPI评分低危、中危和高危组患者5年OS、PFS率逐渐降低,差异有统计学意义(P<0.05)。结论:MALT-IPI评分适用于中国人群;相较于IPI评分,MALT-IPI评分对MALT淋巴瘤患者预后具有更好的评估价值。
Objective:To explore the applicability of mucosa-associated lymphoid tissue(MALT)International Prognostic Index(MALT-IPI)in Chinese patients with MALT lymphoma and compare the prognostic value of different risk stratification methods for MALT lymphoma.Methods:A total of 129 patients with MALT lymphoma diagnosed and treated in Zhongshan Hospital,Fudan University between January 2007 and December 2016 were analyzed retrospectively.Survival analysis was performed according to the MALT-IPI and IPI scoring system.Results:The median age of patients was 56 years old(range,22-82 years old).Fifty-three patients(41.1%)had gastric MALT lymphoma.Lung involvement was found in25.6% cases.More than half of patients presented with limited stage disease(71 patients stageⅠ-Ⅱ,55.1%)at diagnosis,and the remaining 58(44.9%)patients were in stage Ⅲ-Ⅳ.The median follow-up period was 26 months(range,1-378 months).The 5-year overall survival(OS)rate and 5-year progression-free survival(PFS)rate were 90.23% and 69.41%,respectively.For IPI scoring system,the 5-year PFS rate in low-,low-intermediate-,high-intermediate/high-risk groups were74.8%,65.2%,and 58.2%,respectively(P=0.125);while for the MALT-IPI model,the 5-year PFS rate in low-,intermediate-,high-risk groups for MALT-IPI were 82.4%,58.4%,and 47.2%,respectively(P=0.003).Conclusions:MALT-IPI is suitable for Chinese MALT lymphoma patients.In comparison with IPI,MALT-IPI would be a more proper prognostic index for the prediction of OS and PFS in patients with MALT lymphoma.
Objective:To explore the applicability of mucosa-associated lymphoid tissue(MALT)International Prognostic Index(MALT-IPI)in Chinese patients with MALT lymphoma and compare the prognostic value of different risk stratification methods for MALT lymphoma.Methods:A total of 129 patients with MALT lymphoma diagnosed and treated in Zhongshan Hospital,Fudan University between January 2007 and December 2016 were analyzed retrospectively.Survival analysis was performed according to the MALT-IPI and IPI scoring system.Results:The median age of patients was 56 years old(range,22-82 years old).Fifty-three patients(41.1%)had gastric MALT lymphoma.Lung involvement was found in25.6% cases.More than half of patients presented with limited stage disease(71 patients stageⅠ-Ⅱ,55.1%)at diagnosis,and the remaining 58(44.9%)patients were in stage Ⅲ-Ⅳ.The median follow-up period was 26 months(range,1-378 months).The 5-year overall survival(OS)rate and 5-year progression-free survival(PFS)rate were 90.23% and 69.41%,respectively.For IPI scoring system,the 5-year PFS rate in low-,low-intermediate-,high-intermediate/high-risk groups were74.8%,65.2%,and 58.2%,respectively(P=0.125);while for the MALT-IPI model,the 5-year PFS rate in low-,intermediate-,high-risk groups for MALT-IPI were 82.4%,58.4%,and 47.2%,respectively(P=0.003).Conclusions:MALT-IPI is suitable for Chinese MALT lymphoma patients.In comparison with IPI,MALT-IPI would be a more proper prognostic index for the prediction of OS and PFS in patients with MALT lymphoma.
引文
[1]International Non-Hodgkin’s Lymphoma Prognostic Factors Project.A predictive model for aggressive non-Hodgkin’s lymphoma[J].N Engl J Med,1993,329(14):987-994.
[2]THIEBLEMONT C,CASCIONE L,CONCONI A,et al.AMALT lymphoma prognostic index[J].Blood,2017,130(12):1409-1417.
[3]SABATTINI E,BACCI F,SAGRAMOSO C,et al.WHOclassification of tumours of haematopoietic and lymphoid tissues in 2008:an overview[J].Pathologica,2010,102(3):83-87.
[4]MOORMEIER J A,WILLIAMS S F,GOLOMB H M.The staging of non-Hodgkin’s lymphomas[J].Semin Oncol,1990,17(1):43-50.
[5]CHESON B D,PFISTNER B,JUWEID M E,et al.Revised response criteria for malignant lymphoma[J].J Clin Oncol,2007,25(5):579-586.
[6]ARMITAGE J O,WEISENBURGER D D.New approach to classifying non-Hodgkin’s lymphomas:clinical features of the major histologic subtypes.Non-Hodgkin’s Lymphoma Classification Project[J].J Clin Oncol,1998,16(8):2780-2795.
[7]ZUCCA E,CONCONI A,PEDRINIS E,et al.Nongastric marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue[J].Blood,2003,101(7):2489-2495.
[8]OLSZEWSKI A J,CASTILLO J J.Survival of patients with marginal zone lymphoma:analysis of the Surveillance,Epidemiology,and End Results database[J].Cancer,2013,119(3):629-638.
[9]LóPEZ-GUILLERMO A,MONTSERRAT E,BOSCH F,et al.Applicability of the International Index for aggressive lymphomas to patients with low-grade lymphoma[J].J Clin Oncol,1994,12(7):1343-1348.
[10]CORTELAZZO S,ROSSI A,OLDANI E,et al.The modified International Prognostic Index can predict the outcome of localized primary intestinal lymphoma of both extranodal marginal zone B-cell and diffuse large B-cell histologies[J].Br J Haematol,2002,118(1):218-228.
[11]HEILGEIST A,MCCLANAHAN F,HO A D,et al.Prognostic value of the Follicular Lymphoma International Prognostic Index score in marginal zone lymphoma:an analysis of clinical presentation and outcome in 144patients[J].Cancer,2013,119(1):99-106.
[12]OH S Y,KWON H C,KIM W S,et al.Nongastric marginal zone B-cell lymphoma:a prognostic model from a retrospective multicenter study[J].Cancer Lett,2007,258(1):90-97.
[13]KHALIL M O,MORTON L M,DEVESA S S,et al.Incidence of marginal zone lymphoma in the United States,2001-2009with a focus on primary anatomic site[J].Br JHaematol,2014,165(1):67-77.
[14]ZHANG Y,WEI Z,LI J,et al.Molecular pathogenesis of lymphomas of mucosa-associated lymphoid tissue--from(auto)antigen driven selection to the activation of NF-kappaBsignaling[J].Sci China Life Sci,2015,58(12):1246-1255.
[15]NAKAMURA S,SUGIYAMA T,MATSUMOTO T,et al.Long-term clinical outcome of gastric MALT lymphoma after eradication of Helicobacter pylori:a multicentre cohort follow-up study of 420patients in Japan[J].Gut,2012,61(4):507-513.
[2]THIEBLEMONT C,CASCIONE L,CONCONI A,et al.AMALT lymphoma prognostic index[J].Blood,2017,130(12):1409-1417.
[3]SABATTINI E,BACCI F,SAGRAMOSO C,et al.WHOclassification of tumours of haematopoietic and lymphoid tissues in 2008:an overview[J].Pathologica,2010,102(3):83-87.
[4]MOORMEIER J A,WILLIAMS S F,GOLOMB H M.The staging of non-Hodgkin’s lymphomas[J].Semin Oncol,1990,17(1):43-50.
[5]CHESON B D,PFISTNER B,JUWEID M E,et al.Revised response criteria for malignant lymphoma[J].J Clin Oncol,2007,25(5):579-586.
[6]ARMITAGE J O,WEISENBURGER D D.New approach to classifying non-Hodgkin’s lymphomas:clinical features of the major histologic subtypes.Non-Hodgkin’s Lymphoma Classification Project[J].J Clin Oncol,1998,16(8):2780-2795.
[7]ZUCCA E,CONCONI A,PEDRINIS E,et al.Nongastric marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue[J].Blood,2003,101(7):2489-2495.
[8]OLSZEWSKI A J,CASTILLO J J.Survival of patients with marginal zone lymphoma:analysis of the Surveillance,Epidemiology,and End Results database[J].Cancer,2013,119(3):629-638.
[9]LóPEZ-GUILLERMO A,MONTSERRAT E,BOSCH F,et al.Applicability of the International Index for aggressive lymphomas to patients with low-grade lymphoma[J].J Clin Oncol,1994,12(7):1343-1348.
[10]CORTELAZZO S,ROSSI A,OLDANI E,et al.The modified International Prognostic Index can predict the outcome of localized primary intestinal lymphoma of both extranodal marginal zone B-cell and diffuse large B-cell histologies[J].Br J Haematol,2002,118(1):218-228.
[11]HEILGEIST A,MCCLANAHAN F,HO A D,et al.Prognostic value of the Follicular Lymphoma International Prognostic Index score in marginal zone lymphoma:an analysis of clinical presentation and outcome in 144patients[J].Cancer,2013,119(1):99-106.
[12]OH S Y,KWON H C,KIM W S,et al.Nongastric marginal zone B-cell lymphoma:a prognostic model from a retrospective multicenter study[J].Cancer Lett,2007,258(1):90-97.
[13]KHALIL M O,MORTON L M,DEVESA S S,et al.Incidence of marginal zone lymphoma in the United States,2001-2009with a focus on primary anatomic site[J].Br JHaematol,2014,165(1):67-77.
[14]ZHANG Y,WEI Z,LI J,et al.Molecular pathogenesis of lymphomas of mucosa-associated lymphoid tissue--from(auto)antigen driven selection to the activation of NF-kappaBsignaling[J].Sci China Life Sci,2015,58(12):1246-1255.
[15]NAKAMURA S,SUGIYAMA T,MATSUMOTO T,et al.Long-term clinical outcome of gastric MALT lymphoma after eradication of Helicobacter pylori:a multicentre cohort follow-up study of 420patients in Japan[J].Gut,2012,61(4):507-513.