| ObjectiveTo investigate the prognostic indicators and clinical characteristics of childhood non-Hodgkin's lymphoma(NHL)in the First Affiliated Hospital of Zhengzhou University through retrospective analysis of clinical data,and provide a reference for its diagnosis,treatment and prognostic evaluation.Methods1.The characteristics of childhood NHL were summarized through collecting and analyzing the clinical data of 189 NHL patients from January 2012 to December2017 in The First Affiliated Hospital of Zhengzhou University Hospital.136 cases with complete initial diagnosis data were followed up by telephone for survival after treatment.To analyze the 5-year cumulative event-free survival rate and 5-year cumulative survival rate,as well as the influence of gender,age,serum albumin,giant tumor,liver and spleen involvement,clinical stage,immune typing,bone marrow and central nervous system involvement on survival condition.2.Statistical methods:All data were analyzed using SPSS 21.0 statistical software for statistics.Classified data were expressed in rate(%).Quantitative data that do not normal distribution were expressed in median.Chi-square test Wilcoxon rank sum test used for comparison between groups.Log rank test and Breslow test were used for univariate survival analysis.Cox regression was used for multivariate survival analysis.P<0.05 for the difference was statistically significant.Results1.From 2012 to 2017,the number of NHL patients was 15,25,29,26,43 and51 respectively.2.The top five areas were Nanyang,Zhumadian,Zhengzhou,Zhoukou and Shangqiu.The total number accounted for 55.6%(104/187)of the province.Patients from rural areas accounted for 76.7%(145/189).There was no significant difference in age,stage and course between patients from rural and urban areas(?~2=0.597,0.178,1.968,P=0.440,0.673,0.161),and there was significant difference in gender(?~2=4.418,P=0.042).3.Of all the 189 patients,the ratio male to female was 4.9:1,the median age is8.1(0.9-13.9)years old.The cases in the 0-4,5-9 and 10-14 age groups were 60,69and 60 respectively.Among them,the number of cases in Burkitt's lymphoma(BL)at0-4,5-9 and 10-14 years old is 34,20 and 14,showed a downward trend,while lymphoblastic lymphoma(LBL)is 12,21 and 24,anaplastic large cell lymphoma(ALCL)is 9,10 and 12,showed the opposite trend.4.The course of disease was mostly within 2 months,accounting for72.0%(136/189)of the total.Mass was the most common,accounting for 43.4%,followed by digestive system(29.6%)and respiratory system symptoms(21.2%).The clinical manifestations of different pathological types of NHL are different.BL is mainly characterized by digestive system symptoms(35/68),ALCL(15/31)and B-LBL(10/15)by mass,NK/T cell lymphoma(9/14)by cranial facial symptoms(62.5%),T-LBL(24/41)and diffuse large B cell lymphoma(DLBCL)(9/14)by respiratory system symptoms.5.Lymph nodes(86.8%)were the most common involved organs,followed by gastrointestinal tract(20.1%).The most common initial regions of lymph nodes were cervical and abdomen.6.Of all the 189 patients,BL(36.0%),LBL(30.2%),ALCL(16.4%)and DLBCL(7.4%)were the most common pathological types.7.The clinical stages are mostly advanced(III and IV),accounting for 75.1%.8.Up to the deadline of follow-up,45 of 136 patients with complete data of newly diagnosed cases had relapsed/refractory diseases,of which 35 cases(77.8%)had relapsed/refractory diseases within one year after starting treatment.9.The 5-year cumulative event-free survival rate of 136 children were 62.7%,and the 5-year cumulative survival rate was 87.8%.10.Univariate analysis and cox regression multivariate analysis showed that LDH?2 times the upper limit of normal range(P=0.015)and central nervous system involvement(P=0.002)were poor prognostic factors,while gender,age,symptoms B,serum albumin,liver and spleen involvement,bone marrow involvement,giant tumor,advanced stage(stage III,stage IV)had no effect on survival rate.Conclusions1.The total number of children hospitalized with NHL showed an upward trend in the past 6 years.There was no difference in age,stage and course between children from rural and urban areas.2.Childhood NHL is more common in male,and 5-9 years old is a relatively high incidence age stage.Among them,BL showed a downward trend at 0-4,5-9 and10-14 years old,while LBL and ALCL showed the opposite trend.3.The course of disease was mostly within 2 months.The most common clinical manifestation is mass and different among different pathological types.Most of the patients were in advanced stage.BL,LBL,ALCL and DLBCL were the most common pathological types.4.Central nervous system involvement,LDH?2 times the upper limit of normal range are independent risk factors affecting prognosis. |
PDF Full Text Request