Endoscopic and clinicopathological characteristics of gastrointestinal adult T-cell leukemia/lymphoma
Endoscopic and clinicopathological characteristics of gastrointestinal adult T-cell leukemia/lymphoma
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DOI：
10.21037/jgo.2019.03.03
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发表时间：
2019-08-01
影响因子：
2.1
通讯作者：
Takeshita, Morishige
中科院分区：
文献类型：
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作者：
Ishibashi, Hideki;Nimura, Satoshi;Takeshita, Morishige
背景资料：成人T细胞白血病/淋巴瘤（ATLL）经常累及胃肠道（GI），尽管进行了强化细胞毒性治疗，但患者主要表现为侵袭性临床病程。方法：对54例ATLL患者的61个胃肠道病变进行回顾性分析。结果：36例（67%）为淋巴瘤型ATLL，18例（33%）为急性白血病型ATLL。胃和肠（小肠和结直肠）检查的ATLL病变分别为40（66%）和21（34%）。胃ATLL病变常见于淋巴瘤型（29/38; 76%），而急性型病变（11/23; 48%; P=0.023）。肠ATLL病变在急性型（12/23; 52%）与淋巴瘤型病变（9/38; 24%; P=0.023）中较常见。内镜下，与急性型病变（10/23; 44%; P=0.0096）相比，淋巴瘤型ATLL病变中肿瘤形成型病变（29/38; 76%）的发生率显著更高。浅表扩散型在急性型病变中的发生率（12/23处病变; 52%）显著高于淋巴瘤型病变（3/38处; 8%; P=0.0003）。此外，胃病、肠道病或直肠结肠炎样病变也是明显特征，主要是急性型（9/23处病变; 39%）。39个肿瘤形成型病灶中有23个（59%）明显由多形性或间变性大细胞淋巴瘤组成，15个浅表扩散型病灶中有13个（87%）明显由多形性中型细胞组成（P=0.007）。与48例晚期患者相比，6例（11%）根据限制的临床分期估计为原发性GI ATLL的患者显示出显著更好的总生存期（OS）（P=0.017）。20例单发肿瘤形成型病变患者的OS显著优于17例多发肿瘤形成型（P=0.015）和5例粘膜增厚型病变（P=0.04）。26例多形性或间变性大细胞型ATLL的预后明显好于28例多形性中型ATLL（P=0.034）。ATLL的白血病行为对肿瘤位置和胃肠道病变的内镜特征有很大影响。胃病、肠病和直肠结肠炎样病变表现出额外的独特特征。早期临床阶段的原发性GI ATLL、孤立性肿瘤形成型病变和大肿瘤细胞分别比其他因素显示出更好的预后因素。
Background: Adult T-cell leukemia/lymphoma (ATLL) frequently involves the gastrointestinal (GI) tract, and patients mainly show an aggressive clinical course despite of intensive cytotoxic treatments. We investigated the characteristic clinicopathological and endoscopic features of GI ATLL.Methods: This was a retrospective analysis of 61 GI tract lesions in 54 ATLL patients.Results: Thirty-six (67%) patients were classified as having lymphoma-type ATLL and 18 (33%) patients were classified as having acute-type with leukemic changes. Examined ATLL lesions in the stomach and intestine (small intestine and colorectum) were 40 (66%) and 21 (34%), respectively. Gastric ATLL lesions were frequently found in the lymphoma-type (29/38; 76%) compared with the acute-type lesions (11/23; 48%; P=0.023). Intestinal ATLL lesions were frequent in the acute-type (12/23; 52%) compared with the lymphoma-type lesions (9/38; 24%; P=0.023). Endoscopically, tumor-forming type lesions were significantly more frequent in lymphoma-type ATLL lesions (29/38 lesions; 76%) compared with acute-type lesions (10/23; 44%; P=0.0096). The superficial spreading-type was significantly more frequent in acute-type lesions (12/23 lesions; 52%) compared with lymphoma-type lesions (3/38; 8%; P=0.0003). Additionally, gastropathy-, enteropathy-, or proctocolitis-like lesions were distinct features, mainly in the acute type (9/23 lesions; 39%). Twenty three of 39 tumor-forming-type lesions (59%) were significantly composed of pleomorphic or anaplastic large cell lymphoma, and 13 of 15 superficial spreading-type lesions (87%) were significantly composed of pleomorphic medium-sized cells (P=0.007, in each). Six patients (11%) who were estimated as having primary GI ATLL based on restricted clinical stages, showed a significantly better overall survival (OS) compared with the 48 advanced-stage patients (P=0.017). Twenty patients with solitary tumor-forming-type lesions showed a significantly better OS than 17 patients with the multiple tumor-forming-type (P=0.015) and five with the mucosal-thickening-type lesions (P=0.04). Twenty-six patients with pleomorphic or anaplastic large cell ATLL showed a significantly better prognosis compared with 28 patients with pleomorphic medium-sized ATLL (P=0.034).Conclusions: ATLL predominantly involves the stomach. Leukemic behavior of ATLL had a large influence on the tumor location and endoscopic features of GI tract lesions. Gastropathy-, enteropathy-, and proctocolitis-like lesions showed additional distinct characteristics. Primary GI ATLL in the early clinical stages, solitary tumor-forming-type lesions and large tumor cells showed better prognostic factors than other factors, respectively.