目的探讨眼附属器淋巴瘤的临床分期及不同危险因素对预后的影响。
方法采用双向队列研究方法，收集2010年11月至2018年12月在天津医科大学眼科医院经病理学检查确诊为原发性眼附属器淋巴瘤患者的临床资料，共74例。根据局部肿瘤范围、淋巴结或全身受累情况进行TNM分期；根据淋巴结、结外器官受累情况进行Ann Arbor分期；根据世界卫生组织关于淋巴瘤的分类进行病理学分型。随访疾病进展或死亡的结局。采用Kaplan-Meier法进行单因素生存分析；采用Cox比例风险模型进行多因素生存分析预测影响预后的危险因素，估算风险比( HR)及其95%置信区间( CI)。
结果TNM分期中<T4期68例，占91.9%，T4期6例，占8.1%；N0期71例，占95.9%，≥N1期3例，占4.1%；无M期病例。Ann Arbor分期中ⅠE期72例，占97.3%，ⅡE期2例，占2.7%。病理类型中，结外边缘区黏膜相关淋巴组织(MALT)型淋巴瘤64例，占86.5%，非MALT型淋巴瘤10例，占13.5%。74例患者随访3~117个月，中位数为53个月。因本病死亡6例，疾病进展19例。总体3年和5年生存率分别为96.6%和86.6%。总体3年和5年无进展生存率分别为75.6%和65.9%。在单因素作用下，T4期、非MALT型淋巴瘤、Ki67阳性率≥10%为降低总生存率的相关因素( P<0.05)。T4期、≥N1期、≥Ann Arbor Ⅱ期、非MALT型淋巴瘤、Ki67阳性率≥10%为降低无进展生存率的相关因素( P<0.05)。在多因素作用下，病理类型( HR＝33.193，95% CI：3.388~325.156， P＝0.003)是影响总生存率的唯一危险因素；N分期( HR＝11.683，95% CI：2.720~50.173， P＝0.001)、病理类型( HR＝11.337，95% CI：3.841~33.464， P<0.001)为影响无进展生存率的独立危险因素。
结论TNM分期和病理类型是眼附属器淋巴瘤重要的临床预后指标。TNM分期高或非MALT型淋巴瘤患者应密切随访。
ObjectiveTo evaluate the influence of the clinical staging and different risk factors for the prognosis of ocular adnexal lymphoma.
MethodsAn ambispective cohort study was conducted.Seventy-four patients diagnosed with primary ocular adnexal lymphoma by pathology at Tianjin Medical University Eye Hospital from November 2010 to December 2018 were enrolled.TNM staging was performed according to local tumor extent, lymph node or systemic involvement.Ann Arbor staging was carried out according to lymph node involvement and extranodal extension.The pathological subtype was classified according to World Health Organization classification of lymphoma.The outcome of disease progression or death was analyzed.Kaplan-Meier method was used for univariate survival analysis.Cox proportional hazard model was employed for multivariate survival analysis to predict the risk factors affecting prognosis, hazard ratio ( HR) and 95% confidence interval ( CI) were estimated.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Tianjin Medical University Eye Hospital (No.2021KY[L]-32). Written informed consent was obtained from all patients before entering the cohort.
ResultsFor TNM staging, there were 68 cases in stage <T4, accounting for 91.9%, 6 cases in T4, accounting for 8.1%, 71 cases in N0, accounting for 95.9%, 3 cases in ≥N1, accounting for 4.1%, and no case was in stage M. For Ann Arbor staging, there were 72 cases in stage ⅠE, accounting for 97.3%, and 2 cases in stage ⅡE, accounting for 2.7%.As for pathological classification, 64 cases had mucosa-associated lymphoid tissue (MALT) lymphoma, accounting for 86.5% and 10 cases had non-MALT lymphoma, accounting for 13.5%.The follow-up of the patients was 3 to 117 months, with a median follow-up of 53 months.There were 6 cases dying of disease and 19 cases progressed.The 3-year and 5-year overall survival rates were 96.6% and 86.6%, respectively.The 3-year and 5-year progression-free survival rates were 75.6% and 65.9%, respectively.According to single-factor analysis, T4 stage, non-MALT type and Ki67 positive rate ≥10% were related to declined overall survival rate ( P<0.05). T4 stage, ≥N1 stage, ≥Ann Arbor Ⅱ stage, non-MALT type and Ki67 positive rate ≥10% were related to declined progression-free survival rate ( P<0.05). According to multiple-factor analysis, pathological type ( HR=33.193, 95% CI: 3.388-325.156, P=0.003) was the independent risk factor for overall survival rate.N stage ( HR=11.683, 95% CI: 2.720-50.173, P=0.001) and pathological type ( HR=11.337, 95% CI: 3.841-33.464, P<0.001) were independent risk factors for progression-free survival rate.
ConclusionsTNM staging and pathological type are important clinical prognostic indicators for ocular adnexal lymphoma.Patients with high TNM stage or non-MALT lymphoma should be monitored closely.
简天明,高飞,杨婉晨,等. 眼附属器淋巴瘤临床分期和预后危险因素评估[J]. 中华实验眼科杂志,2022,40(08)：743-751.
DOI:10.3760/cma.j.cn115989-20211231-00727版权归中华医学会所有。
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简天明：研究设计、实施研究、采集/分析数据、论文撰写和修改；高飞、杨婉晨：整理/分析数据、论文修改；唐东润、何彦津：病例收集、实施研究；孙丰源：研究设计、分析数据、论文修改及定稿
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