原发性甲状腺淋巴瘤疗效分析(附20例报道)

Therapeutic Effect of Primary Thyroid Lymphoma:Analysis of 20 Cases

目的分析原发性甲状腺淋巴瘤的临床表现、病理分型、诊治手段及预后。方法对2002年1月至2014年2月期间笔者所在医院收治的20例原发性甲状腺淋巴瘤患者的临床病理资料进行回顾性分析。结果20例原发性甲状腺淋巴瘤患者中,女14例,男6例;年龄45～77岁,中位年龄为63.5岁。其中7例（35.0%）为弥漫性大B细胞型淋巴瘤,12例（60.0%）为黏膜相关淋巴组织型结外边缘区B细胞型淋巴瘤,1例（5.0%）为滤泡性淋巴瘤。其中合并桥本甲状腺炎12例。行单纯手术治疗6例（30.0%）,手术后行化疗和（或）放疗13例（65.0%）,行单纯化疗联合放疗1例（5.0%）。除2例患者（10.0%）失访外,18例（90.0%）患者获随访,随访时间为6～104个月,中位随访时间为46.5个月。随访期间因肿瘤复发而死亡6例,其2年累积生存率为74.4%,5年累积生存率为66.9%。结论原发性甲状腺淋巴瘤病理类型大多为B细胞来源的非霍奇金淋巴瘤,且与慢性淋巴细胞性甲状腺炎密切相关;手术切除多为病理确诊用,应根据病理学类型和临床分期个体化地选择放化疗综合治疗,以获得较好的预后。

Objective To summarize the clinical and pathological manifestation, therapy, and prognosis of primary thyroid lymphoma（PTL）. Methods The clinical and pathological data of 20 patients with PTL treated in our hospital from Jan.2002 to Feb.2014 were retrospectively analyzed. Results Of the 20 patients, 14 patients were female, 6 patients were male. The median age were 63.5 years old（45-77 years old）. Seven patients（35.0%） were diffused large B-cell lymphoma（DLBCL）, and 12 patients（60.0%） were extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue（MALT） lymphoma, 1 patient（5.0%） was follicular lymphoma（FL）. Twelve patients complicated with Hashimoto thyroiditis. Six patients（30.0%） accepted surgery only, 13 patients（65.0%） were supplemented with chemotherapy and（or） radiotherapy, 1 patient（5.0%） accepted chemotherapy and radiotherapy only. Two patients lost during follow-up, but 18 patients were followed-up for 6-104 months with the median time of 46.5 months. During the follow-up period, 6 patients died of PTL. The cumulative survival rates of 2-year and 5-year were 74.4% and 66.9%, respectively. Conclusions Most PTL are B-cell original non-Hodgkin lymphoma. In order to get good prognosis, chemotherapy and（or） radiotherapy are mostly needed, while surgery is performed for definitive pathological diagnosis.