原发性甲状腺非何杰金氏淋巴瘤临床预后分析  

Primary thyroid lymphoma-clinical and prognosis factors analysis of 43 cases

作　　者：杨焕军[1] 王达飞 陈忠伟[3] 稽庆海[4] 梁世雄[1] 付小龙[1] 蒋国梁[1] 

机构地区：[1]复旦大学附属肿瘤医院放疗科,上海200032 [2]江苏省宜兴市中医院放疗科 [3]复旦大学附属肿瘤医院病理科 [4]复旦大学附属肿瘤医院外科

出　　处：《实用肿瘤学杂志》2004年第6期406-410,共5页Practical Oncology Journal

摘　　要：目的　探讨原发性甲状腺非何杰金氏淋巴瘤(PTL)临床特点、诊断措施,治疗的选择及影响局部控制和预后因素。方法　1 972年1月～2 0 0 2年1 2月我院收治PTL 4 3例,对其临床表现特点及治疗结果进行分析。统计应用SPSS 1 0中的卡方检验、寿命表法、logrank检验及COX回归模型。结果　PTL肿瘤发展时,首先侵犯甲状腺周围的颈内淋巴结,低度恶性PTL无1例发展为高度恶性。总的5年、1 0年生存率分别为78%、71 %,5年、1 0年无瘤生存率分别为78%、78%;死于肿瘤7例,均为Ⅱ期以上,2例有B症状(2 /3) ,4例为弥漫大B细胞淋巴瘤(DLBCL ,4 /5 ) ,COX回归多因素分析示病理类型、颈部有淋巴结转移、分期及全身转移显著影响患者的生存期(P <0 .0 0 1 ) ,病程的长短也影响PTL的预后(P =0 .0 4 9)。局部复发9例,均为单纯手术者(9/1 1 ) ,B症状及治疗方案对肿瘤局部控制有影响(P <0 .0 0 1 ,P =0 .0 0 2 )。结论　PTL是预后较好的一组淋巴瘤。手术的作用明确病理诊断及分类。建议病理类型为粘膜相关淋巴细胞型结外边缘区B细胞淋巴瘤(MZL)和滤泡性淋巴瘤(FL)的IEA单纯术后放射治疗,ⅡEA以上可行术后放疗+化疗。而对于有B症状或/和高度恶性的PTL则应以化疗为主,完全缓解后可考虑局部放疗。Objective To discuss the clinical characters, diagnostic measures, the optimal management and to analyze local control and prognosis factors of primary thyroid lymphoma (PTL).Methods From 1972.1 to 2002.12, there were 43 cases with PTL treated in our hospital, of them, clinical characters and treatment results were analyzed. Statistics of Life table, COX regression and kaplane meier, log rank test were applied with SPPS10 software. Results When PTL had been growing, neck local lymphoid nodes were invaded first, The lowgrade of MZL?FL had good prognosis and less developing high grade lymphoma. The total 5, 10 year survival rates were 78% and 71% respectinely. The 5, 10 year free tumor survival rates were 78% and 78% respectively. Seven pts. with over stage Ⅱ, B symptom (2/3) and DLBCL (4/5) died of PTL. The results of COX regression show that the types of pathology, neck and system metastases, stage, B symptom markedly influenced the survival (P< 0.001). The course of diseases also influenced the prognosis (P= 0.049). Nine pts. received thyroid operation had recurrences (9/11). The approaches of treatment influenced local control (P= 0.002)? Conclusion PTL had good prognosis. The pts with I EA low grade lymphoma may treated only with radiotherapy (RT) and Ⅱ EA with RT+chemotherapy (CT) after thyroid resection. But the pts with B symptom and/or high grade lymphoma should received CT which was stronger than CHOP. The local RT may given after the pts had complete release of diseases.

关 键 词：甲状腺 非何杰金氏淋巴瘤 肿瘤 原发性 临床预后分析 病理类型 生存率 滤泡 EA FL 

分 类 号：R736.1[医药卫生—肿瘤]