原發(fā)性眼部淋巴瘤的臨床分析及治療預后
發(fā)布時間：2018-09-10 19:47
【摘要】：目的:眼部淋巴瘤發(fā)病率低、初期診斷困難,本研究針對眼部淋巴瘤的起病受累部位、臨床特點、病理分型、診斷及治療方案、預后進行評估,尤其針對眼附屬器MALT淋巴瘤患者的預后因素進行分析,為標準化方案的制定提供臨床資料。方法:收集我院自2000年1月至2016年12月經(jīng)眼部活組織檢查及免疫組化確診的眼部淋巴瘤患者,其中包括原發(fā)性眼內淋巴瘤患者共10例,眼附屬器淋巴瘤患者共86例,對比患者臨床特點、早期表現(xiàn)、受累部位、病理分型、治療方法、預后隨訪評估。病例的臨床分期應用Ann-Arbor法,治療療效的評估按照IWG評價標準,數(shù)據(jù)分析應用SPSS軟件,Kaplan-Meier曲線計算生存率,并用Log-rank法進行檢驗;定性資料的分析采用卡方和Fisher確切概率檢驗。結果:共收集原發(fā)性眼部淋巴瘤96例,原發(fā)性眼附屬器淋巴瘤(POALs)的86例患者中,眼眶受累者64例(74.42%),結膜受累者21例(24.42%),淚腺受累者1例(1.16%)。病理分型以B細胞來源為主(84例),其中MALT淋巴瘤最為常見,共78例(90.70%)。來診患者臨床表現(xiàn)不典型,但多由于腫瘤所導致的占位表現(xiàn)。影響POALs預后的因素包括病理類型、治療方案,而發(fā)病部位不作為影響預后的危險因素。Ann-Arbor分期I期的MALT淋巴瘤患者緩解率和5年無進展生存率高,單純手術治療組5年無進展生存率較放療組及手術聯(lián)合放療組生存率低。原發(fā)性眼內淋巴瘤(PIOL)患者共10例,表現(xiàn)為玻璃體受累者8例,以單眼受累居多。其主要臨床表現(xiàn)為眼部異物感、畏光、視物模糊。所有患者的病理學分型均為彌漫大B細胞淋巴瘤,單眼受累的7名患者給予局部治療(玻璃體腔注射劑聯(lián)合局部放療),均獲得完全緩解,其中3例患者復發(fā),補救治療效果欠佳,2例死亡,1例患者隨訪3個月無復發(fā);2例雙眼同時受累的患者應用局部治療(玻璃體腔注射+局部放療)聯(lián)合全身化療,隨訪12-22個月未復發(fā);雙眼受累合并神經(jīng)系統(tǒng)癥狀的1例老年患者給予利妥昔單抗未獲得緩解,經(jīng)治無效死亡。結論:1)在原發(fā)性眼部淋巴瘤患者中,POALs所占比例遠高于PIOL,其中眼眶為最常見的好發(fā)部位,其次為結膜。PIOL好發(fā)于玻璃體。2)POALs患者中最常見的病理類型為MALT淋巴瘤,其次為濾泡性淋巴瘤;PIOL患者最常見的病理學類型為彌漫大B細胞淋巴瘤。3)POALs患者的預后較為理想,影響因素主要包括病理分型、治療方案,其中以MALT淋巴瘤的預后最為理想;IE期的MALT淋巴瘤患者單純手術治療更易出現(xiàn)遠期復發(fā)或進展,而局部放療或放療聯(lián)合手術治療方案則具有較高的5年無進展生存率。4)原發(fā)性眼內淋巴瘤的惡性程度高、侵襲性大,無共識性一線治療方案,治療方案的選擇需根據(jù)受累部位評估。
[Abstract]:Objective: the incidence of ocular lymphoma is low and the initial diagnosis is difficult. In this study, the location, clinical features, pathological classification, diagnosis and treatment, prognosis of ocular lymphoma were evaluated. The prognostic factors of ocular adnexal MALT lymphoma were analyzed in order to provide clinical data for the establishment of standardized protocol. Methods: from January 2000 to December 2016, 10 cases of ocular lymphoma were diagnosed by ocular biopsy and immunohistochemistry, including 10 cases of primary intraocular lymphoma and 86 cases of ocular adnexal lymphoma. The clinical features, early manifestations, site of involvement, pathological classification, treatment, and prognosis were compared. Ann-Arbor method was used to evaluate the therapeutic effect according to IWG evaluation standard. The survival rate was calculated by SPSS software Kaplan-Meier curve and tested by Log-rank method. The qualitative data were analyzed by chi-square and Fisher exact probability test. Results: among 96 cases of primary ocular lymphoma and 86 cases of primary ocular adnexal lymphoma, 64 cases (74.42%) were involved in orbit, 21 cases (24.42%) were involved in conjunctiva, 1 case (1.16%) was involved in lacrimal gland. The pathological classification was mainly B cell origin (84 cases), of which MALT lymphoma was the most common, 78 cases (90.70%). The clinical manifestations of these patients are not typical, but most of them are caused by tumors. The factors influencing the prognosis of POALs included pathological type, treatment regimen, and the location of the disease was not a risk factor for prognosis. The remission rate and 5-year progression-free survival rate of patients with stage I MALT lymphoma in Ann-Arbor stage were high. The 5-year progression-free survival rate in the simple operation group was lower than that in the radiotherapy group and the surgery combined radiotherapy group. There were 10 cases of primary intraocular lymphoma (PIOL) with vitreous involvement in 8 cases, most of which were monocular involvement. The main clinical manifestations are ocular foreign body sensation, photophobia and blurred vision. All patients were classified as diffuse large B-cell lymphoma, 7 patients with monocular involvement were treated with local therapy (vitreous injection combined with local radiotherapy), and 3 of them relapsed. There were 2 patients who died after 3 months follow up and 2 patients with bilateral involvement were treated with local therapy (local intravitreal injection radiotherapy) combined with systemic chemotherapy, followed up for 12 to 22 months without recurrence. One elderly patient with binocular involvement and neurological symptoms received rituximab without remission and died after treatment. Conclusion (1) the percentage of POALs patients with primary ocular lymphoma is much higher than that with PIOL,. The most common location is orbital, followed by conjunctival. PIOL. 2) MALT lymphoma is the most common pathological type in POALs patients. Secondly, the most common pathological type of follicular lymphoma was diffuse large B-cell lymphoma (3. 3) the prognosis of POALs patients was satisfactory. The main influencing factors included pathological classification and treatment plan. Among them, MALT lymphoma patients with MALT lymphoma had the most ideal prognosis in IE stage and were more likely to have long term recurrence or progression after simple surgical treatment. Local radiotherapy or radiotherapy combined with surgery had a higher 5-year progression-free survival rate (.4) primary intraocular lymphoma had a higher degree of malignancy, greater invasiveness, and no consensus first-line treatment. Treatment options need to be evaluated according to the site involved.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.7
本文編號：2235435
[Abstract]:Objective: the incidence of ocular lymphoma is low and the initial diagnosis is difficult. In this study, the location, clinical features, pathological classification, diagnosis and treatment, prognosis of ocular lymphoma were evaluated. The prognostic factors of ocular adnexal MALT lymphoma were analyzed in order to provide clinical data for the establishment of standardized protocol. Methods: from January 2000 to December 2016, 10 cases of ocular lymphoma were diagnosed by ocular biopsy and immunohistochemistry, including 10 cases of primary intraocular lymphoma and 86 cases of ocular adnexal lymphoma. The clinical features, early manifestations, site of involvement, pathological classification, treatment, and prognosis were compared. Ann-Arbor method was used to evaluate the therapeutic effect according to IWG evaluation standard. The survival rate was calculated by SPSS software Kaplan-Meier curve and tested by Log-rank method. The qualitative data were analyzed by chi-square and Fisher exact probability test. Results: among 96 cases of primary ocular lymphoma and 86 cases of primary ocular adnexal lymphoma, 64 cases (74.42%) were involved in orbit, 21 cases (24.42%) were involved in conjunctiva, 1 case (1.16%) was involved in lacrimal gland. The pathological classification was mainly B cell origin (84 cases), of which MALT lymphoma was the most common, 78 cases (90.70%). The clinical manifestations of these patients are not typical, but most of them are caused by tumors. The factors influencing the prognosis of POALs included pathological type, treatment regimen, and the location of the disease was not a risk factor for prognosis. The remission rate and 5-year progression-free survival rate of patients with stage I MALT lymphoma in Ann-Arbor stage were high. The 5-year progression-free survival rate in the simple operation group was lower than that in the radiotherapy group and the surgery combined radiotherapy group. There were 10 cases of primary intraocular lymphoma (PIOL) with vitreous involvement in 8 cases, most of which were monocular involvement. The main clinical manifestations are ocular foreign body sensation, photophobia and blurred vision. All patients were classified as diffuse large B-cell lymphoma, 7 patients with monocular involvement were treated with local therapy (vitreous injection combined with local radiotherapy), and 3 of them relapsed. There were 2 patients who died after 3 months follow up and 2 patients with bilateral involvement were treated with local therapy (local intravitreal injection radiotherapy) combined with systemic chemotherapy, followed up for 12 to 22 months without recurrence. One elderly patient with binocular involvement and neurological symptoms received rituximab without remission and died after treatment. Conclusion (1) the percentage of POALs patients with primary ocular lymphoma is much higher than that with PIOL,. The most common location is orbital, followed by conjunctival. PIOL. 2) MALT lymphoma is the most common pathological type in POALs patients. Secondly, the most common pathological type of follicular lymphoma was diffuse large B-cell lymphoma (3. 3) the prognosis of POALs patients was satisfactory. The main influencing factors included pathological classification and treatment plan. Among them, MALT lymphoma patients with MALT lymphoma had the most ideal prognosis in IE stage and were more likely to have long term recurrence or progression after simple surgical treatment. Local radiotherapy or radiotherapy combined with surgery had a higher 5-year progression-free survival rate (.4) primary intraocular lymphoma had a higher degree of malignancy, greater invasiveness, and no consensus first-line treatment. Treatment options need to be evaluated according to the site involved.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.7
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