悪性リンパ腫の病期分類

Staging of Malignant Lymphoma

悪性リンパ腫で最も用いられる病期分類は，Ann Arbor分類（Cotswolds改訂）である．消化管悪性リンパ腫では深達度や多臓器への浸潤を考慮したLugano国際会議分類を使用することがある．悪性リンパ腫の初期評価に必要なものはPS（performance status），臨床検査では血液学的検査，肝炎ウイルス，HIV，肝機能，腎機能，LDH，免疫グロブリン，骨髄生検が必要である．この他に，アンスラサイクリン系抗癌剤を使用する場合は心エコーが必要である．画像診断は（頸部）胸部，腹部，骨盤CTである．PETもしくはPET-CTはびまん性大細胞型リンパ腫やHodgkinリンパ腫では推奨されるが，MALTリンパ腫では推奨されない．治療前の病期分類は治療方針の決定に重要なため，きちんと行うべきである．

　Malignant lymphoma is generally staged using Cotswold's modification of the Ann Arbor staging system. However, this staging system does not incorporate data regarding the depth of tumor invasion, which is known to affect the prognosis. The Lugano staging system was developed to incorporate the measurement of the tumor depth, and measures of distant nodal involvement. Other than the Ann Arbor staging system, the Lugano staging system is the most widely accepted to stage primary gastrointestinal lymphomas. Laboratory tests and imaging studies should be performed at the initial diagnosis of patients with lymphoma to establish the extent of the disease. The tests should include a complete blood count ; bone marrow biopsy ; assessment of renal and hepatic function, including excreted lactate dehydrogenase levels ; testing for human immunodeficiency virus, human T-cell leukemia virus type 1, hepatitis B, and hepatitis C viruses ; testing for electrolytes and uric acid ; and computed tomography scans of the chest, abdomen, and pelvis. Positron emission tomography scanning before treatment is recommended only for certain lymphomas that are routinely glucose labeled（e.g., diffuse large B cell lymphoma and Hodgkin's lymphoma）. Adequate staging is very important because the treatment approach and prognosis are strongly dependent on this information.