鼻腔原发非霍奇金氏淋巴瘤的临床特征及预后分析

Clinical features and prognostic analysis of primary nasal non Hodgkin's lymphoma

分析鼻腔原发非霍奇金氏淋巴瘤(non Hodgkin'slymphoma,NHL)的临床特征和影响预后的因素。方法 :回顾性研究1982年至1999年本院38例原发于鼻腔及鼻窦的NHL的临床特点、诊断及治疗。结果 :38例患者按照AnArbor分期 ,Ⅰ期14例 ,Ⅱ期11例 ,Ⅲ期7例 ,Ⅳ期6例 ,就诊主要症状为鼻塞、流涕和鼻衄等 ,11例 (29 % )伴有发热、盗汗或体重下降等全身症状。38例患者淋巴瘤细胞为小细胞至大细胞性等多种类型 ,病变内常见坏死改变 ,25例进行免疫表型分析 ,全部为T细胞性。除6例早期患者单独放疗、7例化疗外 ,其余25例采用放化疗综合治疗。全组预期5年生存率65 % ,早期局限病变 (Ⅰ、Ⅱ期组 )79 45 % ,晚期病变 (Ⅲ、Ⅳ期组 )为0 ,两组生存率差别显著(χ2=15 57,P<0 001)。结论 :临床分期为鼻腔原发NHL的主要预后因素 ,早期局限病变疗效较好 ;晚期病变发展迅速 ,常规治疗预后差 。

Objective: To investigate the clinical characteristics and prognostic factors of patients with primary nasal non Hodgkins lymphoma(NHL) Methods: The clinical features, diagnosis and treatment of 38 patientswith NHL occurring in nasal cavities and paranasal sinuses between 1982 and 1999 were retrospectively analyzed Results: The Ann Arbor stages were: stage Ⅰ,14 patients; stage Ⅱ, 11 patients; stage Ⅲ, 7 patients; and stage Ⅳ,6 patients The most common symptoms at the presentation included nasal obstruction, rhinorrhea and epistaxis 11 patients (29%) had B symptoms (fever, night sweat, and/or weight loss) The lymphoma cells in all the cases ranged in size from small to large, and necrosis was common Immunophenotyping were determined in 25 cases and all were T cell type 6 cases with early localized disease were treated with radiotherapy and 7 had chemotherapy, the remaining 25 cases received combined chemotherapy and radiotherapy The 5 year overall survival (OS) for the entire group was 65%, and those for patients with localized disease (stages Ⅰand Ⅱ) and those with the advanced disease (stages Ⅲand Ⅳ) were79 45%and 0, respectively (χ2=15 57,P<0 001) Conclusions: Stage of disease is a strong predictor of outcome for primary nasal NHL The patients with localized disease had a relatively favorable prognosis The advanced disease mayprogress rapidly and have unfavorable prognosis if it were treated with conventional chemotherapy, and therefore, further studies are required to improve the outcome