原发性甲状腺非霍奇金淋巴瘤临床生物特点及预后因素分析  

Clinico-biological characteristics of primary thyroid non-hodgkin’s lymphoma and its significance

作　　者：杨焕军[1] 梁世雄[1] 陈忠伟[2] 稽庆海[3] 王达飞 

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

出　　处：《上海医学》2005年第6期490-494,共5页Shanghai Medical Journal

摘　　要：目的探讨原发性甲状腺非何杰金淋巴瘤(PTL)的临床生物学特点及临床意义。方法1972年1月至2002年12月我院共收治PTL43例,对其临床表现及预后进行分析,观察PTL肿瘤发展规律及影响预后的因素。应用SPSS10软件,采用卡方检验、寿命表法、Kaplan-Meier法及COX风险回归模型进行统计学分析。结果患者5、10年总生存率分别为78%和71%,5、10年无瘤生存率均为78%。单因素及多因素分析显示,病理类型、颈部淋巴结转移、分期和B症状(即全身症状,如发热、盗汗、体重减轻等)显著影响患者的生存期(P<0.001),病程长短也影响PTL的预后(P=0.049),年龄不是影响预后的因素。PTL病情进展时,肿瘤沿甲状腺淋巴引流区扩散,未发现跳跃性。两叶以上病灶者颈内淋巴结转移率为50%(7/14例),显著高于单叶者的14%(4/29例,P<0.05)。有淋巴结转移者的远处转移率及肿瘤相关死亡率高于无淋巴结转移者(P值均<0.01)。弥漫性大B细胞淋巴瘤(DLBCL)患者的淋巴结转移率、远处转移率、肿瘤相关死亡率高于滤泡型淋巴瘤(FL)和黏膜相关淋巴细胞型结外边缘区B细胞淋巴瘤(MZL)患者(P<0.01)。未观察到低度恶性PTL转化为高度恶性淋巴瘤。MZL和FLⅠ期患者无论采用何种治疗,均可获得长期生存;对不利预后因素(DLBCL、FLⅡ期以上和B症状)患者,给予以阿霉素为主的化疗方案,仍难以控制肿瘤的进展。结论PTL具有自己的临床生物特点和发展规律,根据其临床生物特性制定治疗策略较为恰当。Objective To analyze the clinico-biological characteristics and its clinical significance of primary thyroid non-hodgkin’s lymphoma (PTL).Methods From 1972 Jan. to 2002 Dec., 43 cases of PTL were treated in our hospital. The clinical presentations and outcomes of the treatment were analyzed to fetch the clinico-biologi-cal characteristics. Survival and prognostic factors were analyzed with Kaplan- Meier, COX proportional hazards progression model and their correlative outcomes were tested with Log-Rank test and Chi-square test (SPSS 10 software). Results The overall survival rates at 5, 10 years were 78% and 71% respectively and the disease-free survival rates were both 78%. The results of univariate analysis and COX proportional hazards regression model showed that the pathologic pattern, cervical lymph node metastasis, staging and B symptoms markedly influenced the survival period(P<0.001). The duration of illness also affected the prognosis (P=0.049), but not the age. When the disease progressed, the cancer spread along the lymphatics,with higher intracervical lymph node metastasis in bilateral thyroid lesions than those of unilateral lesions, 50% vs 14%(P<0.05). The rates of distant metastasis and mortality were higher in those with lymph node metastesis than those without(P all <0.01). There were higher lymph nodes metastasis, distanct metastasis and tumor associated mortality in patients with diffuse large B-cell lymphomas (DLBCL) than those with follicular lymphomas(FL) and extranodal marginal zone lymphomas (P<0.01).None of those with pathological low-grade malignant lymphoma transformed into high grade ones. No matter which kind of management given to patients with (stage Ⅰ) MZL and FL, all can have long survival whereas those with unfavorable prognostic factors [DLBCL, lymph node(s) metastasis and B symptoms] progressed even if they were treated with CHOP or COMP.Conclusion PTL possesses its own clinical biological characteristics and rules of development and it is more eligible to adopt treatment s

关 键 词：原发性甲状腺非霍奇金淋巴瘤 临床生物特点 疾病预后 阿霉素 化学治疗 

分 类 号：R736.1[医药卫生—肿瘤]