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摘要: 目的 探讨原发性骨淋巴瘤(PBL)的临床特征及其对预后的影响。方法 对2014年12月—2019年12月收治的12例PBL患者资料进行回顾性分析，探讨其临床特征及预后影响因素。结果 12例患者病理类型均为弥漫大B细胞淋巴瘤，其中男5例，女7例；中位年龄59岁；主要发病部位为股骨(4例)和脊柱(3例)；6例行放化疗联合治疗，6例行单纯化疗；全组患者中位随访时间为38.4个月，中位无进展生存时间为14.4(95%CI 9.5~19.3)个月，中位总生存时间为22.1(95%CI 11.1~33.1)个月。单因素分析结果显示，美国东部肿瘤研究组(ECOG)评分、有无软组织侵犯、初始治疗是否达完全缓解与总生存时间有关，β2微球蛋白水平、有无软组织侵犯与无进展生存时间有关(P＜0.05)。而国际淋巴瘤预后指数(IPI)评分无论对于总生存时间还是无进展生存时间均差异无统计学意义。多因素分析结果提示，β2微球蛋白水平是影响患者无进展生存时间的独立预后因素(P＜0.05)。结论 IPI对PBL患者预后的影响仍需进一步讨论，β2微球蛋白处于正常水平的PBL患者预后较好。可考虑根据β2微球蛋白水平，探讨针对PBL更合适的IPI评分模型。Abstract: Objective To investigate the clinical features and prognosis of primary bone lymphoma(PBL).Methods The clinical data of 12 patients with PBL from December 2014 to December 2019 were retrospectively analyzed to explore the clinical characteristics and prognostic factors.Results The pathological type of 12 patients was diffuse large B-cell lymphoma, including 5 males and 7 females, with a median age of 59 years old. The main sites were femur(4 cases) and spine(3 cases). Six patients received combined radiotherapy and chemotherapy, and 6 patients received chemotherapy alone. The median follow-up time was 38.4 months, the median progression-free survival was 14.4(95%CI 9.5-19.3) months, and the median overall survival was 22.1(95%CI 11.1-33.1) months. Univariate analysis showed that ECOG score, presence or absence of soft tissue invasion and initial treatment of complete remission were associated with overall survival, while β2 microglobulin level and the presence or absence of soft tissue invasion were associated with progression-free survival(P < 0.05). IPI score has no statistical significance for overall survival or progression-free survival. Multivariate analysis indicated that β2 microglobulin level was an independent prognostic factor of progression-free survival(P < 0.05).Conclusion The influence of IPI on the prognosis of PBL patients still needs further discussion. The prognosis of PBL patients with normal β2 microglobulin levels is better. A more appropriate IPI scoring model could be explored based on the level of β2 microglobulin.
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Key words:
- primary bone lymphoma /
- clinical features /
- prognosis
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表 1 影响12例PBL患者预后的单因素分析
影响因素 例数 OS/月 PFS/月 中位值(95%CI) P 中位值(95%CI) P 性别 0.320 0.437 男 5 35.6(6.6~64.6) 14.4(12.7~16.1) 女 7 19.8(17.5~22.1) 16.5(6.5~26.5) 年龄/岁 0.840 0.576 ≥60 6 22.1(12.7~31.5) 13.6(11.4~15.8) ＜60 6 20.2(1.2~39.2) 16.5(4.2~28.8) 分子亚型 0.298 0.372 GCB 7 19.8(17.5~22.1) 24.5(11.3~37.7) non-GCB 5 35.6(21.7~49.5) 13.6(11.0~16.2) 骨病变数量 0.294 0.388 单个 6 未达到 14.4(6.9~21.9) 多个 6 19.8(16.0~23.6) 9.2(0~18.7) 分期 0.416 0.974 ⅠE+ⅡE期 7 36.6(4.0~67.2) 14.4(12.3~16.5) Ⅳ期 5 22.1(15.2~29.0) 16.5(0~33.5) ECOG评分 0.003 0.073 ≤2 7 未达到 24.5(3.8~45.2) ＞2 5 18.9(8.6~29.2) 12.6(5.3~19.9) 周围软组织侵犯 0.001 0.003 无 6 18.9(12.1~25.7) 24.5(18.0~31.0) 有 6 未达到 9.2(4.4~14.0) IPI评分 0.892 0.379 ≤2 6 20.2(1.2~39.2) 14.4(0~32.8) ＞2 6 22.1(12.7~31.5) 13.6(9.0~18.3) LDH/(U·L-1) 0.246 0.662 ＜240 4 未达到 13.6(1.1~26.1) ≥240 8 19.8(18.0~21.6) 14.4(9.0~19.8) β2微球蛋白 0.243 0.004 正常 7 35.6(17.3~53.9) 24.5(15.8~33.2) 升高 5 20.2(7.1~33.3) 12.6(4.0~21.2) 联合放疗 0.983 0.768 有 6 20.2(5.0~35.4) 13.6(11.4~15.8) 无 6 22.1(12.7~31.5) 16.5(1.1~31.9) 初始CR 0.027 0.086 否 5 19.8(17.9~21.7) 12.6(5.3~19.9) 是 7 未达到 24.5(3.8~45.2) 利妥昔单抗 0.903 0.135 未使用 6 22.1(13.8~30.4) 12.6(7.3~17.9) 使用 6 20.2(4.2~36.2) 16.5(0.4~32.6) 
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表 2 影响12例PBL患者PFS的Cox多因素分析
影响因素 β SE Wald χ2 HR 95%CI P β2微球蛋白 -2.677 1.333 4.036 0.069 0.005~0.937 0.045 ECOG评分 -1.227 1.468 0.699 0.293 0.016~5.206 0.403 软组织侵犯 -1.177 1.250 0.887 0.308 0.027~3.571 0.887 初始反应 0.350 1.481 0.056 1.419 0.078~25.878 0.813
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