Ⅰ期非霍奇金淋巴瘤复发病例的再治疗和预后

Salvage treatment and prognosis of recurrent Stage Ⅰ non Hodgkin lymphoma

目的 分析Ⅰ期非霍奇金淋巴瘤疗后复发病例再治疗的结果及可能与预后有关的因素。方法 本院收治的 187例Ⅰ期NHL随诊发现 38例出现疗后复发。病理类型为低度恶性 2例 ,中度恶性 16例 ,高度恶性 19例 ,未分类型 1例。首程治疗距复发的间隔时间 2 2例 (5 7.9% ) <2 4个月 ,16例≥ 2 4个月 ,中位复发时间为 2 1个月。原发部位复发 8例 ,远处孤立性复发病灶 16例 ,广泛播散性复发 14例。再程治疗情况 :放射治疗 3例 ,化疗 16例 ,化疗 +放射治疗 9例 ,5例复发后未接受再程治疗 ,4例复发后是否治疗不详 ,1例复发后失随。应用Kaplan Meier方法进行生存分析 ,Logrank方法进行差异检验。结果 全组病例复发后 1、3年生存率分别为 73.5 %、48.3%。复发后接受治疗的2 8例 ,复发后 1、2、3年生存率分别为 88.5 %、6 0 .5 %、5 4.5 %。首程治疗距复发的间隔时间 <2 4个月2 2例 ,1、2年生存率分别为 6 7.5 %、42 .8% ;≥ 2 4个月 16例 ,1、2年生存率分别为 80 .0 % ,6 4.0 % ,二者差异无显著性意义 (P >0 .0 5 )。远处单发病灶复发 16例 ,1、2年生存率分别为 78.8% ,70 .0 % ;广泛播散性复发 14例 ,1、2年生存率分别为 49.0 %、32 .7% ,二者差异有显著性意义 (P <0 .0 5 )。

Objective To evaluate the treatment results and prognostic factors of recurrent Stage Ⅰ non Hodgkin's lymphoma(NHL). Methods From Jan. 1987 to Dec. 1993, 38 of 187 patients with Stage Ⅰ NHL treated in our hospital developed recurrence. Twenty two patients relapsed within 24 months after primary treatment and sixteen more than 24 months,with a median recurrence time of 21 months. The sites of recurrence were in the primary in 8 patients, single distant organ or tissue in 16 patients and multiple disseminated lesions in 14 patients. The salvage treatment consisted of radiotherapy in 3 cases chemotherapy in 16, and chemotherapy plus radiotherapy in 9. Five patients refused any treatment and one was lost to follow up. In 5 patients, treatment option was unclear. Kaplan Meier method was used for survival analysis. The difference of survival between two groups was evaluated by Logrank. Results The overall post recurrence survivals at 1 and 3 year were 73.5% and 48.3% , respectively. For 28 patients who received salvage treatment, the overall post recurrence survivals at 1 and 3 year were 88.5% and 54.5%, respectively. The 1 and 2 year post recurrence survival rates for patients with recurrent interval time < 24 moths and > 24 months were 67.5% and 42.8%, 80.0% and 64.0% respectively. The 1 and 2 year post recurrence survival rates for patients with single recurrent lesion and multiple disseminated lesions were 78.8% and 70.0%, 49.0% and 32.7% respectively. The difference was statistically significant (P=0.023). Conclusion Some of patients with recurrent NHL can be salvaged by radiotherapy, chemotherapy or both. Patients with single distant recurrent lesion had a better prognosis than those with multiple disseminated lesions.