ⅠE和ⅡE期原发性甲状腺非霍奇金淋巴瘤临床预后分析  

Primary thyroid non-Hodgkin＇s lymphoma of Ann Arbor stagesⅠ E and Ⅱ E： prognostic factors

作　　者：马永群[1] 曹志伟[2] 石胜利[1] 

机构地区：[1]中国医科大学附属第四医院耳鼻咽喉头颈外科,沈阳110032 [2]中国医科大学附属盛京医院耳鼻咽喉头颈外科

出　　处：《中华耳鼻咽喉头颈外科杂志》2009年第4期272-276,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨原发性甲状腺非霍奇金淋巴瘤的预后因素。方法回顾性分析1981年1月至2008年1月收治的47例甲状腺非霍奇金淋巴瘤ⅠE和ⅡE期患者，所有病例均经病理诊断为B细胞来源非霍奇金淋巴瘤，弥漫性大B细胞淋巴瘤（diffuse large B—cell lymphoma，DLBCL）28例，黏膜相关淋巴样组织淋巴瘤（mucosa-associated lymphoid tissue，MALT）19例。生存率统计采用Kaplan—Meier法，组间生存率的比较应用Log—rank检验，多因素分析采用Cox回归模型，分析年龄、性别、症状、肿瘤分期、肿瘤浸润范围、病理类型、治疗方式和放疗照射剂量等多种因素对预后的影响。结果全组5年癌症相关生存率为61．8％。单因素分析显示原发肿瘤局限于甲状腺组与超出甲状腺被膜组的5年生存率分别为86．7％与50．0％（P=0．012）。放疗剂量不足40Gy组与超过40Gy组的5年生存率分别为30．8％与79．0％（P=0．002）。27例ⅡE期患者中采用单一治疗方法和多种治疗方法的5年生存率分别为33．3％和61．1％（P=0．037）。病理类型为DLBCL与MALT两组的5年生存率分别为50．0％与79．0％（P=0．038）。Cox回归多因素分析显示浸润范围、放疗剂量、病理类型、ⅡE期患者治疗方式是影响预后的危险因素（OR值分别为11．108、5．466、4．071、3．058，P值均〈0．05）。结论病变是否局限于甲状腺，放疗的剂量以及病理类型是影响原发甲状腺非霍奇金淋巴瘤（ⅠE和ⅡE期）预后的重要因素。ⅡE期患者综合治疗的疗效优于单一治疗方式。Objective To investigate the prognostic factors of primary non-Hodgkin＇s thyroid lymphoma. Methods From January 1981 to January 2008, 47 patients with stage Ⅰ E and Ⅱ E pathologically confirmed as suffering from B cell non-Hodgkin＇s lymphoma and treated in hospital, were retrospectively analyzed. Pathology ： diffuse large cell B-cell lymphoma （ DLBCL ） 28, mucosa-assoeiated lymphoma（MALT） 19. The cancer specific survival （CSS） were calculated using the Kaplan-Meier method and compared by the Log-rank test. Age, sex, symptoms, extrathyroid extension, radiation doses, treatment modality and histological type characteristics were evaluated using the Cox regression analysis. Results The 5-year CSS rate was 61.8%. The 5-year CSS rate for the patients with primary tumor confined to thyroid and with extrathyroid extension were 86.7% and 50.0% （P = 0. 012）. The 5-year CSS rate for the patients treated with radiation doses below 40 Gy and treated to 40 Gy or more were 30. 8% and 79.0% （ P = 0. 002）. The 5-year CSS rate for the 18 patients with stage Ⅱ received single modality therapy and the muhimodality therapy were 33.3% and 6l. 1% （P =0.037）. The 5-year CSS rate for patients with DLBCL lymphoma lesions and with MALT were 50.0% and 78.9% （ P = 0. 038 ）. Multivariate analysis by Cox regression showed that extrathyroid extension, radiation doses and histological type were independent prognostic factors. Conclusions In primary non-Hodgkin＇ s lymphoma of the thyroid, extrathyroid extension, radiation radiation doses and histological type are important prognostic factors. For patients with the stage Ⅱ received muhimodality therapy have a higher CSS than the ones received single-modalhy therapy.

关 键 词：甲状腺肿瘤 淋巴瘤 非霍奇金 预后 

分 类 号：R686[医药卫生—骨科学]