46例原发扁桃体非霍奇金淋巴瘤的临床分析

Clinical features of 46 patients with primary Non-Hodgkin's lymphoma of the tonsil

目的总结原发扁桃体NHL的临床特点及治疗预后,探讨进一步改善预后和治疗后生存质量的可能途径。方法回顾性分析1996年10月～2002年11月46例初治原发扁桃体NHL患者的临床资料。I期和Ⅱ期患者42例(91.3%)主要接受放化疗联合治疗,Ⅲ期和Ⅳ期患者以化疗为主。46例患者中弥漫大B细胞型36例(78.26%),外周T细胞型5例(10.87%),惰性淋巴瘤3例(6.5%),间变大T细胞型和T淋巴母细胞型各1例。结果全组患者5年总生存率和无病生存率均为71.74%,Ⅰ期和Ⅱ期患者的5年生存率为78.57%。早期患者的生存率与原发耐药、复发和国际预后指数(international Prognostic index,IPI)评分有显著相关;而性别、年龄、病理类型、B症状、是否有巨块等对生存率均无显著性影响。结论原发于扁桃体的NHL绝大部分为Ⅰ期和Ⅱ期的早期患者,因此预后较好。病理类型以弥漫大B细胞型最为多见。C0x回归后分析显示在早期患者中原发耐药、复发和IPI>1是影响预后的主要因素。

Objective To investigate the clinical features of primary non-Hodgkin＇s lymphoma（NHL）of the tonsil, and to explore possible ways to improve the prognosis and quality of life of the patients after treatment.Methods Clinical dats of 46 patients with NHL of the tonsil,treated from October 1996 to November 2002 were retrospectively reviewed.42 （91.3%）were Stage Ⅰ-Ⅱ patients received radiochemotherapy-predominant treatment,whereas stage Ⅲ- Ⅳ patients received chemotherapy-predominant treatment,of the 46 cases,36（78.26%）were diffuse large B-cell subtype, 5（10.87%） were peripheral T-cell subtype, 3（6.5%） were indolent lymphoma, 1 was anaplastic large large T-cell lymphoma,and 1 was T lymphoblastic lymphoma,esults The5-year overall survival rate was 71.74% ,that of stage Ⅰ -Ⅱ patients was 78.57% .Cox regression multivariate analysis showed that the survival rate was correlated to the value of international prognostic index,（IPI）,and whether the patient had primary refractory or relapsed disease, but was not correlated to sex, age, pathologic subtype, B symptoms, and bulky disease.Conclusion Most patients with NHL of the tonsil are at early stages, with good prognosis. Diffuse large B-cell lymphoma is the most common pathologic subtype. Primary refractory, relapse, and IPI〉I are independent prognostic factors.