I_(E)期鼻腔非霍奇金淋巴瘤预后的多因素分析

Multivariate analysis of prognosis of patients with stage I_E non-Hodgkin′s lymphomas of the nasal cavity

目的 探讨影响IE 期鼻腔非霍奇金淋巴瘤患者预后的因素。方法 71例原发于鼻腔非霍奇金淋巴瘤IE 期患者 ,其中 37例病灶局限于鼻腔 (IE 局限组 ) ,34例有鼻腔外侵犯 (IE 超腔组 )。44例为单纯放疗 ,2 7例为放疗加化疗。生存统计采用Kaplan Meier法 ,组间比较采用Log rank检验。多因素分析采用Cox模型。结果 放疗后肿瘤完全消失者 5 ,10年生存率分别为 71.9%和 5 9.7% ,放疗后残留者均为 13.9% (P =0 .0 0 0 4)。IE 局限组 5 ,10年生存率分别为 6 9.8%和 5 6 .7% ,IE超腔组分别为 40 .7%和 35 .6 % ,二者差异有显著性 (P =0 .0 0 47)。年龄≤ 44岁患者的预后明显好于年龄 >44岁者 (P =0 .0 0 0 3)。IE 局限放疗加化疗组和单纯放疗组的 10年生存率分别为 75 .0 %和 5 2 .0 % ,IE 超腔组则分别为 45 .0 %和 37.6 % (P =0 .0 6 44 )。有无B症状对生存率无显著影响 (P =0 .792 )。Cox多因素分析显示 ,放疗近期疗效、肿瘤超腔和年龄是影响预后的独立因素。结论 鼻腔IE 期淋巴瘤的治疗以放疗为主 ,加上化疗能提高远期生存率。放疗近期疗效、临床分期和年龄对预后有显著影响。

Objective To analyze the factors affecting prognosis of patients with primary non Hodgkin′s lymphomas (NHL) of the nasal cavity.Methods From Jan. 1968 to Dec. 1997, a total of 71 pateitns wtih stage I E (Ann Arbor staging system, 1971) primary non Hodgkin′s lymphomas of the nasal cavity were treated in the Tumor Hospital of Sun Yat sen University of Medical Sciences. In 37 of the 71 patients, the lesions were limited in the nasal cavity (limited I E), and in 34, the lesions were locally extended involving the adjacent structures (extended I E) Forty four patients were treated with radiotherapy and 27 with radiotherapy plus chemotherapy. Survival analysis was done by the Kaplan Meier method, and multivariate analysis was carried out using Cox proportional hazard model.Results The 5 and 10 year survival rate was 71.9% and 59.7% respectively in patients who had complete response to radiotherapy. The 5 and 10 year survival rate was both 13.9% in patients who had residual tumors after treatment. The 5 and 10 year survival rate was 69.8% and 56.7% in patients with limited I E lesions, but 40.7% and 35.6% in those with extended I E lesions. The prognosis was better in younger (<44 years) than in older patients. The 10 year survival rate of patients received radiotherapy alone and those combined with chemotherapy was 52.0% and 75.0% respectively for limited I E as compared to 37.6% and 45.0% for exstended I E. B symptoms did not significantly affect clinical outcome. Multivariate analysis showed that the immediate response to radiotherapy, invasion of the primary tumor outside of nasal cavity and patients′ age were independent prognositc factors.Conclusion Radiotherapy is the main treatment method for stage I E non Hodgkin′s lymphoma of the nasal cavity. Addition of chemotherapy can improve long term survival. The local tumor response to radiotherapy, clinical staging and age of patients have significant influence on patients′ prognosis.