| 詹梦娜,田 浩,许 恬.幽门螺杆菌感染在胃弥漫大B细胞淋巴瘤中的临床意义：基于83例患者分析[J].肿瘤学杂志,2021,27(10):841-847. |
| 幽门螺杆菌感染在胃弥漫大B细胞淋巴瘤中的临床意义：基于83例患者分析 |
| Clinical Significance of Helicobacter Pylori Infection on Gastric Diffuse Large B-cell Lymphoma Based on Analysis of 83 Cases |
| 投稿时间：2021-01-21 |
| DOI：10.11735/j.issn.1671-170X.2021.10.B009 |
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| 中文关键词: 弥漫大B细胞淋巴瘤 幽门螺杆菌 药物疗法 预后 |
| 英文关键词:diffuse large B-cell lymphoma helicobacter pylori chemotherapy prognosis |
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| 中文摘要: |
| 摘 要：［目的］ 探讨幽门螺杆菌（helicobacter pylori，Hp）感染与胃弥漫大B细胞淋巴瘤（diffuse large B-cell lymphoma，DLBCL）患者临床病理特征的关系及其对预后的意义。［方法］ 纳入江苏省肿瘤医院2010年5月至2019年12月诊治的83例原发性胃弥漫性大B细胞淋巴瘤患者，根据Hp检测结果分为Hp阳性组(41例)和Hp阴性组(42例)，对病变标本进行免疫组化检测。治疗后，分析患者的预后及其影响因素。［结果］ Hp阳性组的完全缓解(complete response，CR)率明显高于Hp阴性组(75.6% vs 38.0%，P=0.001)。全组患者中位随访时间为53个月(4~127个月)，5年总生存率（overall survival，OS）、无进展生存率(progression-free survival ，PFS)分别为84.8％、79.0％。Hp阳性组患者的预后明显优于Hp阴性组，5年OS分别为95.1％和75.0％（P=0.019），5年PFS分别为92.3％和66.3％（P=0.009）。Hp阴性且行巩固放疗的患者比非巩固放疗患者有明显的生存获益，5年OS分别为86.3％和61.2％（P=0.046）。单因素分析显示，ECOG评分（P=0.018）、临床分期（P=0.001）、IPI评分（P<0.001）、治疗前LDH水平（P<0.001）、血红蛋白水平（P=0.014）、白蛋白水平（P=0.002）、Hp感染（P=0.019）是OS和PFS的影响因素。多因素分析显示，临床分期、治疗前血红蛋白水平是PFS的独立影响因素，临床分期、治疗前LDH水平是OS的独立影响因素。Hp阳性组的C-myc蛋白（P=0.037）及Bcl-2蛋白（P=0.003）表达阳性率明显低于Hp阴性组，但Bcl-6蛋白表达在两组间无明显差异（P=0.931）。Bcl-6蛋白阳性的胃弥漫大B细胞淋巴瘤患者5年OS（P=0.024）和5年PFS（P=0.045）比Bcl-6蛋白阴性患者更佳，而C-myc蛋白和Bcl-2蛋白阳性患者的预后更差。［结论］ Hp阳性的胃弥漫大B细胞淋巴瘤对化疗反应更好，预后更佳。临床或许可以通过Hp检测结果指导患者是否采取巩固放疗。同时，应进一步实施临床和分子研究，以完善胃弥漫大B细胞淋巴瘤的预后评估体系。 |
| 英文摘要: |
| Abstract： ［Objective］ To investigate the relationship between Helicobacter pylori(Hp) infection and clinicopathologic features of gastric diffuse large B-cell lymphoma and its prognostic significance. ［Methods］ 83 patients with primary gastric diffuse large B-cell lymphoma from May 2010 to December 2019 in Jiangsu Cancer Hospital were divided into Hp-positive group(n=41) and Hp-negative group(n=42) according to the results of Hp detection. After the treatments， clinical effect， prognosis and survival analysis were analyzed. ［Results］ The CR rate of Hp-positive group was significantly higher than that of HP-negative group(P=0.001). The median follow-up time was 53 months(4 to 127 months). The 5-year overall survival(OS) rate and progression free survival(PFS) rate were 84.8% and 79.0%， respectively. The prognosis of the Hp-positive group was significantly better than that of Hp-negative group. The 5-year OS rates were 95.1% and 75.0%(P=0.019)， and the 5-year PFS were 92.3% and 66.3%(P=0.009)， respectively. Patients in Hp-negative group and received consolidation radiotherapy had significant superior survival benefits than those received no consolidation radiotherapy. The 5-year OS were 86.3% and 61.2%， respectively(P=0.046). The positive rates of C-myc protein(P=0.037) and Bcl-2 protein(P=0.003) in Hp-positive group were significantly lower than those in HP-negative group. There was no significant difference in Bcl-6 protein expression between the two groups(P=0.931). Compared with Bcl-6 negative expression groups， 5-year OS(P=0.024) and 5-year PFS(P=0.045) were much better in Bcl-6 positive groups， while patients with C-myc and Bcl-2 protein expression had a worse prognosis. Univariate analysis showed that ECOG（P=0.018）， clinical stage（P=0.001）， IPI score（P<0.001），LDH level before the treatment（P<0.001）， hemoglobin level（P=0.014）， albumin level（P=0.002） and Hp status（P=0.019） were prognostic factors of OS and PFS. Multivariate analysis showed clinical stage and hemoglobin level before the treatment were prognostic factors of PFS， while clinical stage and LDH level before the treatment were prognostic factors of OS. ［Conclusion］ Gastric diffuse large B-cell lymphoma patients with Hp-positive respond better to chemotherapy and have a better prognosis. Patients can be instructed by Hp test to decide whether or not to adopt consolidation radiotherapy in clinical. Meanwhile， more clinical and molecular studies should be performed to perfect prognostic evaluation system for gastric diffuse large B-cell lymphoma. |
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