57例鼻腔鼻窦T细胞淋巴瘤临床疗效及预后分析

Clinical effect and prognosis of 57 cases with T cell lymphoma in nasal cavity and paranasal sinuses

目的 探讨鼻腔鼻窦T细胞淋巴瘤临床疗效及预后因素。方法 回顾性分析1983年7月～2001年4月我院收治的57例鼻腔鼻窦T细胞淋巴瘤，其中单纯放疗（R组）22例，放疗＋化疗（R＋C组）35例。Kaplan-Meier法计算3，5年生存率和局控率，Logrank进行显著性检验和单因素分析，Cox模型进行多因素分析。结果 放疗组（R组）和放疗＋化疗组（R＋C组）3，5年生存率分别为64．7％，55．2％和74．4％，69．8％。两组3，5年生存率比较有统计学意义（P〈0．05）。两组3，5年局控率分别为95．4％，87．2％和94．5％，89．7％。两组3，5年局控率比较无统计学意义（P〉0．05）。多因素分析显示，B症状、临床分期、治疗方式和放疗剂量是影响鼻腔鼻窦T细胞淋巴瘤生存率的独立预后因素；影响鼻腔鼻窦T细胞淋巴瘤局控率的独立预后因素是累及部位、临床分期、治疗方式、放疗剂量。结论 放疗＋化疗组（R＋C组）明显提高了鼻腔鼻窦T细胞淋巴瘤3，5年生存率，但不能改善局控率。B症状、临床分期、治疗方式和放疗剂量是影响鼻腔鼻窦T细胞淋巴瘤生存率的重要因素，累及部位、临床分期、治疗方式、放疗剂量与鼻腔鼻窦T细胞淋巴瘤局控有关。

Objective To evaluate the clinical effect and prognostic factors of T cell lymphoma involving nasal cavity and paranasal sinuses. Methods From July 1983 to April 2001, 57 patients with T cell lymphoma in nasal cavity and paranasal sinuses were treated by radiotherapy （R group, 22 cases） and radiotherapy plus chemotherapy （R ＋ C group, 35 cases）. Kaplan-Meier method was used for the calculation of survival rate and local control rate, Cox proportional hazard model for multivariate analysis, Results The 3, 5 year survival rates of R group and R ＋ C group were 64.7% vs 55.2%, 74.4% vs 69.8% respectively, Differences of 3, 5 year survival rates between R group and R ＋ C group were statistically significant （ P〈0.05）. Their 3, 5 year local control rates were 95.4% vs 87.2%, 94.5% vs 89.7%, respectively. The differences were statistically insignificant （ P〉0.05）. The clinical stage, radiotherapy dosage, combined modality therapy and B symptom were the independent prognostic factors for the survival rate. The involved site, clinical stage, radiotherapy dosage were the independent prognostic factors influencing the local control rate.Conclusion The combined modality therapy obviously improves the survival rate of T cell lymphoma in the nasal cavity and paranasal sinuses. The clinical stage, radiotherapy dosage, combined modality therapy and B symptiom are important prognostic factors.