国际预后指数在韦氏环非霍奇金淋巴瘤的预后意义

Prognostic significance of international prognostic index in non-Hodgkin's lymphoma of Waldeyer's ring

目的 分析国际预后指数和原发肿瘤侵犯范围在韦氏环非霍奇金淋巴瘤的预后价值。方法 分析 5 0 7例首程治疗韦氏环NHL ,均用工作分类进行病理分类。根据AnnArbor分期 :Ⅰ期 77例 ,Ⅱ期 313例 ,Ⅲ期 6 3例 ,Ⅳ期 5 4例。根据 1997年美国癌症协会 (AJCC)TNM分期原则 ,T1期 5 1例 ,T2期 2 0 6例 ,T3期 17例 ,T4期 33例。Ⅰ、Ⅱ期行单纯放射治疗或综合治疗 ,Ⅲ、Ⅳ期以化疗为主。结果 全组 5年癌症相关生存率 (CSS)和无病生存率 (DFS)分别为 6 2 %和 5 1%。Ⅰ、Ⅱ、Ⅲ和Ⅳ期的 5年CSS分别为 91%、6 8%、35 %和 2 0 %。T1、T2、T3和T4期的 5年CSS分别为 82 %、6 3%、5 9%和 37%。国际预后指数 (IPI)危险度 0、1和 2 +3分的 5年CSS分别为 73%、5 3%和 2 5 %。Ⅰ期综合治疗和单纯放射治疗的 5年CSS分别为 93%和 90 %。Ⅱ期综合治疗和单纯放射治疗的 5年CSS分别为 6 9%和6 1% (P =0 .0 79) ,5年DFS为 6 2 %和 5 0 % (P =0 .0 37)。多因素回归分析证明 ,一般状态、T分期、AnnArbor分期、B组症状、乳酸脱氢酶和国际预后指数是独立的预后因素。结论 原发肿瘤侵犯范围和国际预后指数是重要的预后因素 ,综合治疗能改善早期韦氏环非霍奇金淋巴瘤的无病生存率。

Objective To investigate the prognostic value of international prognostic index (IPI) and extension of primary tumor in non-Hodgkin's lymphoma of Waldeyer's ring. Methods From January 1983 to December 1997, 507 patients with previously untreated non-Hodgkin's lymphoma of Waldeyer's ring were reviewed. All patients were classified by the Working Formulation. According to the Ann Arbor staging system, 77 patients had stage Ⅰ , 313 stage Ⅱ, 63 stage Ⅲ, and 54 stage Ⅳ disease. According to AJCC TNM staging system 1997, there were 51 patients with T1, 206 with T2, 217 with T3 and 33 with T4 lesions. Patients with stage Ⅰ and Ⅱ diseases were initially treated with combined modality therapy (CMT) or radiotherapy alone, whereas those with stage Ⅲ and Ⅳ lesions received combination chemotherapy as a primary treatment. Results The 5-year cancer specific survival (CSS) and disease-free survival (DFS) for all patients were 62% and 51%, respectively. The 5-year CSS and DFS were 91% and 72% for stage Ⅰ, 68% and 58% for stage Ⅱ, 35% and 19% for stage Ⅲ, and 20% and 16% for stage Ⅳ patients. The differences in survival between stages were statistically significant (P=0.000). According to T stage, the 5-year CSS were 82% for T1, 63% for T2, 59% for T3, and 37% for T4 disease, respectively (P=0.000). IPI is an important prognostic factor. The 5-year CSS were 73% for 0 risk factor, 53% for 1 risk factor, and 25% for 2 or 3 risk factors (P=0.000). In stage Ⅰ patients, the 5-year CSS was 93% for CMT and 90% for radiotherapy alone. For patients with stage Ⅱ disease, the 5-year CSS was 69% for CMT and 61% for radiotherapy alone (P=0.079). The corresponding DFS was 62% for CMT and 50% for radiotherapy alone, respectively (P=0.037). Multivariate analysis by Cox regression showed that performance status, T stage, Ann Arbor stage, B symptom, lactate dehydrogenase (LDH), and IPI were independent prognostic factors. Conclusion IPI and extension of primary tumor are important prognostic factors. Combined modality therapy is able to improve the disease free survival in early stage Non-Hodgkin's lymphoma of Waldeyer's ring.