以化疗为主的综合疗法治疗霍奇金病——附295例长期随访结果分析  

Clinical Results of 295 Patients with Hodgkin's Disease Treatedby Chemotherapy-Predominant Comprehensive Modality

作　　者：黄慧强[1] 姜文奇[1] 王巍[1] 徐光川[1] 张力[1] 何友兼[1] 孙晓非[1] 周中梅[1] 刘冬耕[1] 徐瑞华[1] 林桐榆[1] 滕小玉[1] 刘茂珍[1] 苏义顺[1] 李宇红[1] 林旭滨[1] 管忠震[1] 

机构地区：[1]中山大学肿瘤防治中心内科,广东广州510060

出　　处：《癌症》2002年第12期1345-1349,共5页Chinese Journal of Cancer

摘　　要：背景与目的:霍奇金病(Hodgkinsdisease,HD)是对放化疗敏感的恶性肿瘤,如何提高HD的治疗效果,同时尽量避免不良反应、使患者保持良好的生活质量是目前临床研究的关键问题。本研究回顾性分析我院近30年治疗HD的长期随访结果,以了解HD的远期疗效和不良反应发生情况。方法:回顾性分析1970～2000年间295例HD的临床资料,着重分析1980～2000年间资料比较完整的182例,采用多因素分析方法(Cox模型)分析HD患者的临床特征及治疗方法和预后的关系。结果:295例HD患者均采用以化疗为主的综合方法治疗,中位随访42.9个月(17.0～351.9个月),5、10和20年生存率分别为63.5%、55.8%和47.1%,中位生存期172.3个月(28.0～351.9个月)。其中1980年以后的182例患者采用了比较正规的化疗和放射治疗,5、10、20年生存率及无病生存率分别为79.6%、74.5%、66.8%及74.5%、69.4%、69.4%;远期不良反应发生率低。另外,本组多因素分析结果表明,年龄≥45岁、Ⅲ～Ⅳ期和B症状是预后危险因素(P=0.000,P=0.035和P=0.047)。进一步分析发现,Ⅰ～Ⅱ期比Ⅲ～Ⅳ期预后好,结节硬化型比其他病理类型的预后好。结论:采用以全身化疗为主结合侵犯野放疗的综合方法治疗HD,远期生存率较高,不良反应发生率低,同时该治疗方法简便,适应性强,值得临床推广。Background & Objective:Hodgkins disease (HD) is a chemo and radio sensitive hematologic malignancy. At present, improvement of cure rate, reduction of long term toxicity, and maintenance of good quality of life are the major issues in the treatment of HD. The results of long term follow up from Cancer Center, Sun Yat sen University were analyzed retrospectively in terms of efficacy and late side effects in this article. Methods:The results of 295 patients with histology proven HD from 1970 to 2000,especially from 1980 to 2000 were analyzed. Meanwhile,multivariant analysis (COX model) was employed to determine the prognostic factor. Results:A total of 295 HD patients were treated by chemotherapy predominant comprehensive modality. The 5,10,and 20 years overall survival for 295 HD patients were 63.5%, 55.8%,and 47.1%,respectively,with median survival time of 172.3 months (28 351.9 months) at the median follow up time of 42.9 months (17 351.9 months). The 5,10,and 20 years overall survival and disease free survival were 79.6%,74.5%,and 66.8% as well as 74.5%,69.4%, and 69.4% respectively for the patients treated with regular chemotherapy and radiotherapy from 1980 to 2000 .The incidence rate of late toxicities was low. Multivariate analysis demonstrated that age over 45 year old , B symptoms and stage Ⅲ/Ⅳ were the main prognostic factors (P=0.000,P=0.035,and P=0.047) in this clinical study. The prognosis of the patients with stageⅠ/Ⅱ and nodular sclerosis was better in comparison to stages Ⅲ/Ⅳ and other histologic subtypes. Conclusions: Chemotherapy predominant combined with involved fields irradiation play an important role in HD treatment with promising long term survival and lower late toxicities. Further investigation for this simplified and convenient comprehesive modality is warranted.

关 键 词：治疗 霍奇金病 化学疗法 放射疗法 综合疗法 

分 类 号：R733.1[医药卫生—肿瘤]