| ObjectiveThe present study was conducted to analyze the clinical cases,to improve the awareness of primary gastrointestinal lymphoma and reduce the misdiagnosis rate and the rate of missed diagnosis.MethodsAnalysis of the pathological features,clinical manifestations,auxiliary examination,histopathological types and treatment methods of 141 patients which were diagnosed by endoscopic biopsy or CT guided biopsy or post-operative histopathologic examination in the first affiliated hospital of Zhengzhou University from June 2011 to October 2017.Results1.The 141 cases consisted of 77 males and 64 females,The male:female ratio was 1.2:1.The age ranged from 4 to 80 years,the majority of cases is distributed from 40 to 59 years old.the most common is abdomen pain(74.5%),other non-specific signs or symptoms such as abdominal distension(36.0%),weight loss(33.3%),melena(23.4%),abdominal mass(13.5%)are also common.2.The most common location of the disease is stomach,accounting for 49.6%.Second,intestinal is accounting for 48.9%;Esophagus is rare,accounting for 1.4%.the common single lesion location of gastric lymphoma are gastric body and gastric antrum,accounting for 45.8%.the most common intestinal lymphoma single lesion in the ileum,especially terminal ileum,accounting for 17.4%.Gastric and intestinal multiple lesions accounted for 40% and 28% respectively.3.Anemia accounted for 53.2%,the positive of fecal occult blood test was 56.3%,LDH increased by 25.4%,?2-MG increased by 12.3%,ALB < 30g/L was 19.9%.The detection rate of Hp in patients with gastric lymphoma was 70.0%,and the positive rate was 65.3%.There was No one case Hp detection performed in patients with intestinal lymphoma.4.The CT suspected diagnosis rate,simple endoscopic suspected diagnosis rate,and endoscopic combined biopsy diagnosis rate of gastric lymphoma were 14.1%,20.0% and 84.3% respectively.The suspected diagnosis rate of CT and simple endoscopic,the diagnosis endoscopic combined biopsy of intestinal lymphoma were 26.9%,27.9% and 83.7% respectively.5.According to Lugano staging,48 cases in Stage I,67 cases of Stage II1,28 cases of Stage II2,8 cases of Stage IIE and 19 cases of Stage IV.There are early stage(stage I,II1)and late stage(II2,IIE,IV).In the early stage of the stomach,68.6% of the patients and 47.8% of the late enteric patients were found,and the difference was statistically significant(?2= 3.91,P < 0.05).6.All patients in this group were non-Hodgkin lymphoma,B cells accounted for 92.2%,and T/NK cells accounted for 7.8%.The most common pathological sub-type was DLBCL,accounting for 63.1%,followed by MALT lymphoma,accounting for 21.3%.According to the degree of malignant tumor cells,the MALT lymphoma and MCL lymphoma treated as inert lymphoma,a total of 33 cases,accounted for 23.4%;the rest of the pathological sub-type in aggressive lymphoma,a total of 108 cases,accounting for 76.6%.7.Of the 141 patients,106 were followed up and the follow-up rate was 85.1%.The overall 1-year survival rate was 90.8%,and the 3-year survival rate was 86.7%.Single factor analysis showed that the lesion location,clinical stage,tumor cell source,LDH,?2-MG and ALB were correlated with the prognosis(P < 0.05).Multivariate analysis showed that the lesion location,tumor cell source and ALB less than 30g/L were the adverse factors affecting the prognosis(P < 0.05).8.None of the patients with inert lymphoma who completed follow-up were fatal;Invasive lymphoma patients,17 deaths.In aggressive lymphoma,simple treatment,pure chemotherapy group,surgery combined radiotherapy and(or)chemotherapy group and chemotherapy combined radiotherapy group,the cumulative survival rate in 5 years was 0.0%,70.0%,80.7%,70.0%,difference is statistically significant(?2= 52.019,P = 0.000).The 5-year survival rate was 74.0% and 74.0% in the operation group and the non-surgical group,and the difference was not statistically significant(?2= 0.285,P=0.593).The 5-year survival rate of the combined radiotherapy group and the uncombined radiotherapy group was 92.3% and 72.1% respectively,and the difference was not statistically significant(?2= 1.062,P=0.303).Conclusion1.Primary gastrointestinal lymphoma is most commonly found in the stomach.Gastric lymphoma is common in the stomach and stomach,mostly in the early stage.Intestinal lymphoma is common at the ends of ileum,mostly in the late stage.2.Low suspected diagnostic rate of CT and endoscopy,and combined biopsy can significantly improve the diagnosis rate.3.The source of tumor cells is mainly B cells,and the most common pathological type is DLBCL.4.Intestinal source,T cell source,ALB less than 30g/L,is the adverse prognostic factor of primary gastrointestinal lymphoma.Among them,the adverse prognosis factor of gastrointestinal invasive lymphoma were intestinal source,?2-MG and LDH.Neither operation nor radiotherapy could improve their overall survival. |
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