【摘要】 目的探讨甲状腺非霍奇金淋巴瘤的预后因素和治疗。方法对31例甲状腺非霍奇金淋巴瘤进行回顾性分析。所有病例均经病理诊断为B细胞来源非霍奇金淋巴瘤,其中低度恶性12例,中度恶性13例,高度恶性1例,不能分型5例。根据AnnArbor分期,Ⅰ期9例,Ⅱ期22例。原发病灶局限于甲状腺8例,超出甲状腺包膜外18例,5例资料不全。上纵隔受侵犯12例,未受侵19例。国际预后指数(IPI)为0～1的16例,2～3的9例,6例资料不全。术后化疗7例,放疗8例,化疗加放疗10例,6例术后未行进一步治疗。结果全组5年总生存率(OS)、癌症相关生存率(CSS)和无瘤生存率(DFS)分别为64%、67%和55%。Ⅰ、Ⅱ期5年OS分别为83%、56%(P=0.190),5年CSS分别为83%、60%(P=0.110)。原发肿瘤局限于甲状腺组与超出甲状腺组的5年CSS分别为100%、56%(P=0.040)。治疗前上纵隔受侵组与未受侵组的5年OS、CSS、DFS分别为38%与80%(P=0.020)、38%与85%(P=0.003)、30%与67%(P=0.040)。IPI=0～1的低危组和IPI=2～3的中危组5年OS、CSS分别为75%与42%(P=0.040)、81%与42%(P=0.010)。病理为中高度恶性者14例,3例术后综合治疗者均无瘤存活,术后单一放疗和单化疗的失败率分别为4/7和1/3。结论原发肿瘤是否局限于甲状腺、上纵隔受侵和IPI是原发甲状腺淋巴瘤重要的预后因素;病理为中高度恶性成分者应接受综合治疗。更多还原

【Abstract】 Objective To investigate the prognostic factors and treatment outcome of primary non-Hodgkin’s thyroid lymphoma.Methods From January 1985 to February 2003, 31 patients pathologically confirmed as suffering from B cell non-Hodgkin’s lymphoma and treated in our hospital, were retrospectively analyzed. Pathology: extra-nodal marginal B cell lymphoma (mucosa-associated lymphoma, MALT) 11, diffuse large cell B cell lymphoma 10, diffused mixed cell type 3, B cell lymphoblastoma 1, follicular lymphoma 1, and unclassifiable 5. According to Ann Arbor staging system, there were 9 stage I, 22 stage Ⅱ lesions, the tumor in 8 patients was confined to the thyroid,18 showed extrathyroid extension and 5 patients were excluded due to lack of complete data.Twelve patients had upper-mediastinal involvement simultaneously. According to the international prognostic index (IPI), 16 patients had no or one risk factor (low-risk group), while 9 patients had two or three risk factors (moderate risk group), 6 cases were excluded because of lacking complete data. Seven patients were biopsied only and 24 patients received operation:unilateral lobectomy 10, sub-total thyroidectomy 10 and total thyroidectomy 4. Twenty-five patients were supplemented with chemotherapy and/or radiotherapy: 7 as the former, 8 as the latter and 10 as both. Radiotherapy-linear accelerator 6?MV X-ray irradiation was given: D_T 40-63?Gy(median 50?Gy) to the primary site, the whole cervical areas D_T 40-55?Gy(median 50?Gy), the mediastinum D_T30-50?Gy(median 45?Gy), radiotherapy had to be seceded in two patients due to extra-portal progression of tumor. Chemotherapy was given to 17 patients as multidrug regimen with CHOP for 9 patients, BACOP for 5 and MOPP, CHEP, CBE, each for one patient. Results The overall 5-year survival rate(OS), cancer specific survival rate(CSS) and disease-free survival rate (DFS) for all patients were 64%, 67% and 55%. The 5-year OS and CSS of stage I and stage Ⅱ patients were 83% and 56%(P=0.190), 83% and 60%(P=0.110), respectively. The 5-year CSS for the patients with primary tumor confined to thyroid and with extrathyroid extension were 100% and 56% (P=0.04), respectively. The 5-year OS, CSS, and DFS for patients with upper-mediastinal involvement and without were 38% and 80%(P=0.020), 38% and 85%(P=0.003), 30% and 67%(P=0.040). According to IPI, the 5-year OS, CSS, and DFS for the patients in low-risk group and moderate risk group were 75% and 42%(P=0.040), 81% and 42%(P=0.010), 68% and 33%(P=0.120)respectively. Among the 14 patients pathologically diagnosed as having highly malignant lesions, 3 patients who received postoperative combined modality therapy were alive and disease-free, 4 out of 7 received postoperative radiotherapy and 1 out of three who received postoperative chemotherapy had relapsed disease at the last follow-up. Conclusions In primary non-Hodgkin’s lymphoma of the thyroid, extrathyroid extension, upper-mediastinal involvement and international prognostic index (IPI) are important prognostic factors. Highly malignant thyroid non-Hodgkin’s lymphoma should be treated with multidisciplinary combined therapy.更多还原