鼻咽非霍奇金淋巴瘤的临床与预后分析

Clinical features,treatment and prognosis of 136 patients with primary non-Hodgkin's lymphoma of the nasopharynx

目的 探讨鼻咽非霍奇金淋巴瘤的临床特点、治疗及国际预后指数 (IPI)的应用价值。方法 回顾性分析 1983～ 1997年间 136例首程治疗的鼻咽非霍奇金淋巴瘤患者的临床资料。按照工作分类原则进行分类 ,高度恶性 18例 ,中度恶性 77例 ,低度恶性 2例 ,未分类 39例。根据AnnArbor分期 ,Ⅰ期 2 5例 ,Ⅱ期 91例 ,Ⅲ期 12例 ,Ⅳ期 8例。Ⅰ期单纯放疗 13例 ,综合治疗 12例 ;Ⅱ期单纯放疗 31例 ,综合治疗 5 7例 ,Ⅲ和Ⅳ期以化疗为主。结果 5年和 10年总生存率 (OS)、癌症相关生存率(CSS)和无病生存率 (DFS)分别为 5 6 .2 %和 4 8.3% ,6 1.2 %和 5 8.0 % ,5 1.1%和 4 6 .5 %。IPI为 0 ,1及2～ 3分的 5年CSS分别为 70 .9%、4 4 .9%、30 .0 % (P =0 .0 0 4 )。Ⅰ期化放疗综合治疗和单纯放射治疗的 5年CSS分别为 82 .2 %和 83.1% ,10年CSS分别为 82 .2 %和 6 6 .4 % ,差异无显著性 (P =0 .779)。Ⅱ期综合治疗和单纯放射治疗 5年CSS分别为 70 .9%和 4 6 .0 % ,10年CSS分别为 6 5 .4 %和 4 6 .0 % ,差异有显著性 (P =0 .0 4 )。Cox多因素分析显示 ,影响预后的因素为AnnArbor分期、B组症状和IPI。结论 IPI是判断原发于鼻咽非霍奇金淋巴瘤预后的重要指标 ,Ⅱ期鼻咽非霍奇金淋巴瘤应考虑综合治疗。

Objective To investigate the clinical characteristics,internationa l prognostic index and treatment of primary non-Hodgkin′s lymphoma (NHL) of th e nasopharynx. Methods From January 1983 to December 1997,136 patients with pre viously untreated NHL of the nasopharynx were retrospectively reviewed. All pati ents were confirmed pathologically and classified by Working Formulation system. There were 18 patients with high-grade,77 intermediate,2 low-grade and 39 u nc lassifiable lymphoma. According to Ann Arbor classification,25 patients had sta ge Ⅰ,91 stage Ⅱ,12 stage Ⅲ and 8 stage Ⅳ lesions. Primary therapy was rad iotherapy alone in 13 patients and radiotherapy combined with chemotherapy in 12 patients with stage Ⅰ disease. In 88 patients with stage Ⅱ,radiotherapy alone was giv en to 31 patients,and a combination of radiotherapy and chemotherapy to 57 patients. Che motherapy was primary treatment for advanced stage Ⅲ/Ⅳ diseases. Results The overall survival rate (OS),cancer specific survival rate (CS S) and disease-free survival rate (DFS) at 5 and 10 years for all patients w ere 56.2%,61.2%,51.1% and 48.3%,58.0%,46.5%,respectively. As for inter national prognostic index ( IPI),th e 5-year CSS was 70.9% for 0 risk factor,44.9% for 1 risk factor,30.0% for 2 or 3 ris k factors,respectively ( P = 0.004). For stage Ⅰ patients,the 5-year CS S was 83.1% for RT alone and 82.2% for combined modality therapy,respective ly ( P =0.77 9). For patients with stage Ⅱ,the 5-year CSS was 46.0% for radiotherapy alone and 70.9% for combined modality therapy. There was significant difference between t hem ( P =0.04). Multivariate analysis by Cox regression showed that Ann Arbor stag e,B symptom and IPI were independent prognostic factors. Conclusion Internationa l prognostic index is an important prognostic factor for Non-Hodgkin′s lymphom a of the nasopharynx and the combined modality therapy may be optimal for the stag e Ⅱ patients.