원발 위장관 미만 대 B세포 림프종의 임상상과 International Prognostic Index의 적용
Primary gastrointestinal diffuse large B-cell lymphoma: A clinical analysis of 76 patients with special application of International Prognostic Index for survival
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초록
목적 : 한국에서 원발 림프절외 림프종의 빈도는 서양권에 비하여 높다고 알려져 있다. 원발 위장관 림프종은 림프절외 림프종의 가장 흔한 형태이지만, 국내 환자들의 임상적 특징과 예후인자는 잘 알려져 있지 않다. 본 연구는 단일 기관의 원발 위장관 DLBCL 환자들을 대상으로 임상적 특징과 치료 결과를 살펴보고자 하였다.
Abstract
Background : Primary gastrointestinal lymphoma is one of the most common extranodal lymphomas. The purpose of this study was to collect information on the clinical features and treatment of patients with primary gastrointestinal diffuse large B-cell lymphoma (DLBCL) at a single healthcare facility in Korea. Methods : Between May 1998 and December 2003, 76 primary gastrointestinal DLBCL patients at Asan Medical Center were identified and evaluated. Results : Male patients accounted for 40 cases. The median age was 53 years. A total of 38 patients had primary gastric DLBCL. With a median follow-up of 25 months, the five year overall survival (OS) rate was 61.4% and the five year event free survival (EFS) rate was 59.3%. B symptoms, performance status, LDH levels and involved sites did not affect survival. Twenty-seven patients who underwent primary surgical resection did not demonstrate a difference in survival when compared to patients who did not undergo surgery. However, for intestinal lymphoma, primary surgical resection had a significant influence on EFS (p=0.030). Age (p=0.038), sex (p=0.017), stage (p=0.048), and the number of extranodal sites (p=0.002) were significant factors for EFS. The three year EFS rate for each International Prognostic Index (IPI) risk group was as follows: 78.4% for low risk, 63.7% for low-intermediate risk, 30.0% for high-intermediate risk and 0% for high risk (p=0.002). Cox multivariate analysis revealed that the IPI was the only independent prognostic factor for EFS (p=0.002). Conclusions : Here we report on the unique pattern of clinical features of primary gastrointestinal DLBCL from a single healthcare center in Korea. The IPI system had prognostic value for primary gastrointestinal DLBCL.(Korean J Med 72:11-19, 2007)
참고문헌 (32)
- d’Amore F, "Non‐Hodgkin’s lymphoma of the gastrointestinal tract: a population‐based analysis of incidence, geographic distribution, clinicopathologic presentation features and prognosis", J Clin Oncol, 12, pp.1673~1684 (1994)
- Shih LY, "Non‐Hodgkin’s lymphoma in Asia", Hematol Oncol Clin North Am, 5, pp.983~1001 (1991)
- Mok TS, "Application of the international prognostic index in a study of Chinese patients with non-Hodgkin’s lymphoma and a high incidence of primary extranodal lymphoma", Cancer, 82, pp.2439~2448 (1998)
- Armitage JO, "New approach to classifying non-Hodgkin’s lymphomas: clinical features of major histologic subtypes", J Clin Oncol, 16, pp.2780~2795 (1998)
- The non-Hodgkin’s Lymphoma Classification Project, "A clinical evaluation of the international lymphoma study group classification of non-Hodgkin’s lymphoma", Blood, 89, pp.3909~3918 (1997)
- Hansen PB, "Primary gastrointestinal non-Hodgkin’s lymphoma in adults: a population- based clinical and histopathologic study", J Intern Med, 244, pp.71~78 (1998)
- Krugmann J, "Fend F Primary gastrointestinal B-cell lymphoma", Pathol Res Pract, 197, pp.385~393 (2001)
- International non-Hodgkin’s Lymphoma Prognostic Factor Project, "A predictive model for aggressive non-Hodgkin’s lymphoma", N Engl J Med, 329, pp.987~994 (1993)
- Lewin KJ, "Lymphomas of the gastrointestinal tract: a study of 117 cases presenting with gastrointestinal disease", Cancer, 42, pp.693~707 (1978)
- Musshoff K, "Prognosis of non-Hodgkin’s lymphomas with special emphasis on the staging classification", Z Krebsforsch Klin Onkol Cancer Res Clin Oncol, 83, pp.323~341 (1975)
- Harris NL, "World Health Organization classification of neoplastic disease of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting‐Airlie House, Virginia", J Clin Oncol, 17, pp.3835~3849 (1999)
- Miller TP, "Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate and high‐grade non‐Hodgkin’s lymphoma", N Engl J Med, 339, pp.21~26 (1998)
- Cheson BD, "Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas", J Clin Oncol, 17, pp.1244~ (1999)
- Oken MM, "Toxicity and response criteria of the Eastern Cooperative Oncology Group", Am J Clin Oncol, 5, pp.649~655 (1982)
- Vose JM, "Phase II study of rituximab in combination with CHOP chemotherapy in patients with previously untreated, aggressive non-Hodgkin’s lymphoma", J Clin Oncol, 19, pp.389~397 (2001)
- Bieker R, "Rituximab in combination with platinum‐containing chemotherapy in patients with relapsed or primary refractory diffuse large B-cell lymphoma", Oncol Rep, 10, pp.1915~1917 (2003)
- Ko YH, "REAL classification of malignant lymphoma in Republic of Korea", Cancer, 83, pp.806~812 (1998)
- Koch P, "Primary gastrointestinal non-Hodgkin’s lymphoma: anatomic and histologic distributions, clinical features, and survival data of 371 patients registered in the German multicenter study GIT NHL 01", 92, 2001, pp.19, 3861~3873
- Aozasa K, "Prognostic value of histologic and clinical factor in 56 patients with gastrointestinal lymphoma", Cancer, 61, pp.309~315 (1988)
- Pandey M, "Malignant lymphoma of the gastrointestinal tract", Eur J Surg Oncol, 25, pp.164~167 (1999)
- Sanchez-Bueno F, "Prognostic factors in primary gastrointestinal non‐Hodgkin’s lymphoma: a multivariate analysis of 76 cases", Eur J Surg, 164, pp.385~392 (1998)
- List AF, "Non-Hodgkin’s lymphoma of the gastrointestinal tract: an analysis of clinical and pathologic features affecting outcome", J Clin Oncol, 6, pp.1125~1133 (1988)
- Reynolds VH, "Non-Hodgkin’s lymphoma of the gastrointestinal tract: an analysis of clinical and pathologic features affecting outcome", J Clin Oncol, 6, pp.1125~1133 (1988)
- Lee JY, "Intestinal lymphoma: exploration of the prognostic factors and the optimal treatment", Leuk Lymphoma, 45, pp.339~344 (2004)
- Dragosics B, "Primary gastrointestinal non‐Hodgkin’s lymphomas: a retrospective clinicopathologic study of 150 cases", Cancer, 55, pp.1060~1073 (1985)
- Shui MH, "Recent results of multimodal therapy of gastric lymphoma", Cancer, 58, pp.1389~1399 (1986)
- Gospodarozicz MK, "Outcome analysis of localized gastrointestinal lymphoma treated with surgery and postoperative irradiation", Int J Radiat Oncol Biol Phys, 19, pp.1351~1355 (1990)
- Maor MH, "Stomach conservation in stage IE and IIE gastric non-Hodgkin’s lymphoma", J Clin Oncol, 8, pp.266~271 (1990)
- Gobbi PG, "The role of surgery in the multimodal treatment of primary gastric non-Hodgkin′s lymphomas", Cancer, 65, pp.2528~2536 (1990)
- Sonnen R, "Combined conservative treatment of localized stomach lymphoma", Dtsch Med Wochenschr, 119, pp.863~868 (1994)
- Taal BG, "The clinical spectrum and treatment of primary non-Hodgkin’s lymphoma of the stomach", Ann Oncol, 4, pp.839~846 (1993)
- Cortelazzo S, "Stage-modified international prognostic index effective predicts clinical outcome of localized primary gastric diffuse large B-cell lymphoma", Ann Oncol, 10 (1999)