原发扁桃体非霍奇金淋巴瘤的预后因素

Prognostic factors in patients with primary non-Hodgkin′s lymphoma of the tonsil

目的 评价原发扁桃体非霍奇金淋巴瘤 (NHL)的肿瘤侵犯范围 (T分期 )和国际预后指数 (IPI)的预后价值 ,并对早期患者提出治疗建议。方法 回顾分析 30 6例原发扁桃体NHL。根据AnnArbor分期 ,Ⅰ期 35例 ,Ⅱ期 178例 ,Ⅲ期 4 9例 ,Ⅳ期 4 4例。根据 1997年AJCCTNM分期标准 ,T12 9例 ,T2 14 2例 ,T3117例 ,T4 18例。Ⅰ期单纯放射治疗 12例 ,综合治疗 2 3例 ;Ⅱ期单纯放射治疗 5 7例 ,单纯化疗 2例 ,综合治疗 119例 ;Ⅲ、Ⅳ期以化疗为主。结果 T1、T2、T3和T4的 5年癌症相关生存率 (CSS)分别为 73.8%、5 9.0 %、5 6 .5 %和 2 6 .5 % (P <0 .0 5 ) ;IPI评分 0分、1分和 2或 3分的 5年CSS分别为 6 9.9%、4 9.0 %和 2 5 .0 % (P <0 .0 1)。Ⅱ期单纯放疗和综合治疗的 5年无瘤生存率 (DFS)分别为 4 6 .2 %和 6 0 .4 % (P <0 .0 5 )。多因素分析证明 ,影响预后的因素有一般状态、B症状、AnnArbor分期、T分期和IPI。结论 原发肿瘤T分期和IPI是扁桃体NHL重要的预后因素。综合治疗改善了Ⅱ期扁桃体NHL的DFS。

Objective To investigate the prognostic value of the size of primary tumor (T staging) and international prognostic index (IPI) for patients with non Hodgkin′s lymphoma (NHL) of the tonsil, and to recommend the treatment strategy for early stage patients. Methods 306 patients with untreated NHL of the tonsil were reviewed. According to Ann Arbor staging classification, 35 patients had stage Ⅰ, 178 stage Ⅱ, 49 stage Ⅲ and 44 stage Ⅳ disease. According to 1997′ AJCC staging system, 29 patients had T1,142 T2,117 T3 and 18 T4 disease. Twelve stage Ⅰ patients were given radiotherapy alone and 23 stage Ⅱ patients were given combined modality therapy (CMT). For patients with stage Ⅱ lesion, 57 were given radiotherapy alone, 2 chemotherapy alone and 119 CMT. Chemotherapy was the main treatment in patients with stage Ⅲ or Ⅳ lesions. Results The 5 year cancer specific survival (CSS) was 74% for patients with T 1, 59% for T 2, 56% for T 3 and 26% for T 4, respectively ( P =0.000). The 5 year CSS was 70% for patients with 0 risk factor, 49% for 1 risk factor, 25% for 2 or 3 risk factor, respectively ( P =0.000). CMT significantly improved disease free survival (DFS) from 46% (radiotherapy alone) to 60% (CMT) for stage Ⅱ patients ( P =0.046). Multivariate analysis showed that performance status, Ann Arbor staging, T staging, B symptom, and IPI were independent prognostic factors. Conclusion The T staging of the primary tumor and IPI are the important prognostic factors of patients with NHL of the tonsil. Combined modality therapy significantly improves the disease free survival of stage Ⅱ patients.