单纯甲状腺全切术及联合R-CHOP治疗PTL病情转归评价及影响因素分析

Evaluation of the outcome and analysis of influencing factors of thyroid total resection alone and combined with R-CHOP therapy for PTL

目的评价单纯甲状腺全切术及联合R-CHOP化疗方案治疗原发性甲状腺淋巴瘤(primary thyroid lymphoma,PTL)的病情转归,分析其病情转归影响因素。方法回顾性选取2009年1月至2020年1月山西省肿瘤医院血液科62例PTL患者,年龄(63.51±9.83)岁,男20例,女42例,以Ann Arbor分期及患者意愿为依据,10例接受单纯甲状腺全切术,47例接受甲状腺全切术+R-CHOP,5例接受甲状腺全切术+R-CHOP+放疗治疗,治疗3个月后,收集近期疗效。以随访24个月后患者预后转归情况分组,死亡病例纳入不良组,将生存病例纳入良好组,采用单因素对比分析两组年龄、性别、体质指数(body mass index,BMI)、民族、既往史、肿块大小、美国东部肿瘤协作组体能状况(Eastern Cooperative Oncology Group Performance Status,ECOGPS)评分、Ann Arbor分期、病理类型、B症状、国际预后指数(International Prognostic Index,IPI)评分、治疗方法、甲状腺功能、血红蛋白、血清白蛋白、血小板、白细胞计数、淋巴细胞、中性粒细胞、嗜酸性粒细胞、C反应蛋白、血沉、乳酸脱氢酶(lactate dehydrogenase,LDH)、β2微球蛋白,采用LASSO回归降维筛选影响因素,Logistic回归分析PTL病情转归影响因素。结果62例PTL患者21(33.87%)例完全缓解(complete response,CR),27(43.55%)例部分缓解(partial response,PR),9(14.52%)例稳定(stable disease,SD),5(8.06%)例疾病进展(progressive disease,PD)。随访24个月后,10例接受单纯手术治疗患者病死率为90%(9/10),接受手术+R-CHOP治疗患者病死率为19.15%(9/47),将18例死亡纳入预后不良组,44例生存纳入预后良好组。经单因素、LASSO回归筛选及Logistic回归分析显示,Ann Arbor分期(OR=5.105)、病理类型(OR=3.622)、IPI评分(OR=2.709)、治疗方法(OR=0.730)、血红蛋白(OR=0.392)、LDH(OR=6.469)为PTL病情转归的影响因素(均P<0.05)。结论全切术联合R-CHOP治疗患者预后转归效果优于单独全切术患者,同时患者预后恢复还受Ann Arbor分期、IPI评分等多因素影响,临床可据此完善护理方案,以改善预后。

Objective To evaluate the prognosis of patients with primary thyroid malignant lymphoma(PTL)treated with total thyroidectomy alone or in combination with R-CHOP chemotherapy,and analyze the factors influencing their prognosis.Methods A retrospective analysis was conducted on 62 patients with PTL admitted to the Hematology Department of Shanxi Provincial Cancer Hospital from Jan.2009 to Jan.2020.The patients were with an average age of(63.51±9.83)years,with 20 males and 42 females.According to Ann Arbor staging and patients'wishes,10 cases received simple thyroidectomy,47 cases received total thyroidectomy+R-CHOP,and 5 cases received total thyroidectomy+R-CHOP+radiotherapy.After 3 months of treatment,the short-term curative effect was collected.According to the prognosis of patients after 24 months of follow-up,the dead cases were classified into bad group and the surviving cases into good group.Single factor and LASSO regression dimensionality reduction were used to screen the influencing factors,and Logistic regression analysis was used to analyze the influencing factors of PTL prognosis.Results Among 62 patients with PTL,21(33.87%)had complete response(CR),27(43.55%)had partial response(PR),9(14.52%)had stable disease(SD),and 5(8.06%)had progressive disease(PD).After a follow-up of 24 months,the mortality rate among 10 patients who underwent surgical treatment alone was 90%(9/10),the mortality rate among those who underwent surgical treatment combined with R-CHOP therapy was 19.15%(9/47),18 deaths were categorized as having a poor prognosis,while 44 survivors were classified as having a favorable prognosis.Univariate,LASSO regression screening,and Logistic regression analysis showed that Ann Arbor staging(OR=5.105),pathological type(OR=3.622),international prognostic index(IPI)score(OR=2.709),treatment method(OR=0.730),hemoglobin(OR=0.392),and lactate dehydrogenase(LDH)(OR=6.469)were factors affecting the prognosis of PTL(all P<0.05).Conclusions The combined use of total resection and R-CHOP treatment for patients has a superior prognosis compared to patients undergoing total resection alone.Furthermore,the prognosis of patients is also influenced by factors such as Ann Arbor staging and IPI scoring.Based on this,clinical care plans can be refined to improve the prognosis.