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目的:探讨原发性肾脏恶性淋巴瘤(PRL)的临床病理特征、治疗方法及影响预后的因素。方法:对2013年2月我院收治的1例PRL患者进行报道,同时查询国内2000~2014年正式发表的有关此病的文献报道,收集73例PRL患者资料进行分析。结果:男性略多于女性,高发年龄为50~70岁,中位年龄59岁,单侧多于双侧。最常见的症状为腰痛,其次为发热,血尿、腹痛常有发生。临床和影像学表现不典型,极易误诊为肾癌。病理检查以非霍奇金淋巴瘤常见,其中B细胞淋巴瘤占多数。74例(包括本例)患者中位生存时间为47个月,1、3、5年生存率分别为76.20%,59.90%,43.70%。Log-rank检验单因素分析结果显示:治疗方式、肿瘤病理类型与患者生存时间有关(P<0.05);患者性别、年龄、左右侧、肿瘤大小与患者生存时间无关(P>0.05)。Cox回归模型多因素分析结果显示,治疗方式是PRL患者生存时间的独立影响因素(P<0.05)。治疗方式之间差异有统计学意义(P<0.05),根治性切除后化疗预后最好,根治性切除后化疗+放疗其次。结论:PRL是罕见的疾病,临床和影像学表现不典型,极易误诊为肾癌,确诊依赖于组织病理学检查,预后与病理类型、治疗方式有关。以手术切除+化疗为主的综合治疗预后最好,最值得推荐。
Objective: To investigate the clinicopathological features, treatment and prognostic factors of primary renal malignant lymphoma (PRL). Methods: One PRL patient admitted in our hospital in February 2013 was reported. Meanwhile, the literature about the disease officially published from 2000 to 2014 in China was collected and 73 patients with PRL were collected for data analysis. Results: The male was slightly more than the female, with a high prevalence of 50-70 years and a median age of 59 years, with more unilateral and more bilateral. The most common symptoms are low back pain, followed by fever, hematuria, abdominal pain often occur. Clinical and radiological findings are not typical, easily misdiagnosed as kidney cancer. Pathological examination with non-Hodgkin’s lymphoma common, of which B-cell lymphoma accounted for the majority. The median survival time of 74 patients (including this case) was 47 months, and the survival rates at 1, 3 and 5 years were 76.20%, 59.90% and 43.70% respectively. Log-rank test univariate analysis showed that the treatment mode and tumor pathology were related to the survival time of patients (P <0.05). The gender, age, left and right side, tumor size had no relation with the survival time of patients (P> 0.05). Cox regression model multivariate analysis showed that the treatment is an independent factor affecting the survival time of patients with PRL (P <0.05). The difference was statistically significant (P <0.05). After radical resection, the prognosis of chemotherapy was the best, followed by radical resection followed by chemotherapy and radiotherapy. Conclusion: PRL is a rare disease, clinical and radiological findings are not typical, easily misdiagnosed as renal cell carcinoma, diagnosis depends on histopathological examination, prognosis and pathological types, treatment methods. Surgical resection + chemotherapy-based comprehensive treatment of the best prognosis, the most recommended.