34例原发性甲状腺淋巴瘤的临床特征及预后分析

Clinical characteristics and prognostic analysis of 34 patients with primary thyroid lymphoma

目的探讨原发性甲状腺淋巴瘤(Primary thyroid lymphoma, PTL)的临床特征、诊断、治疗及预后。方法回顾性分析2010年9月至2023年2月北京同仁医院收治的34例新诊断PTL患者的临床和病理资料, 采用Kaplan-Meier生存曲线及Log-rank检验进行生存分析, 预后影响因素分析采用单因素Cox回归模型。结果 34例PTL患者均以颈部肿物为首发临床表现, 男9例, 女25例, 病理诊断为弥漫大B细胞淋巴瘤(DLBCL)、黏膜相关淋巴组织(MALT)淋巴瘤的患者分别为29例、5例。DLBCL患者中, 6例伴有B症状, 17例美国东部肿瘤协作组(ECOG)评分≥2分, Ann Arbor分期为Ⅰ~Ⅱ期21例, Ⅲ~Ⅳ期8例, 肿块长径≥10 cm 4例, 14例合并桥本甲状腺炎;27例接受化疗, 完全缓解(CR)21例, 部分缓解(PR)2例, 疾病进展6例;5年无进展生存率、总生存率分别为78.9%、77.4%;单因素生存分析显示, B症状、肿块长径≥10 cm、Ann Arbor Ⅲ~Ⅳ期是影响患者预后的重要因素(P<0.05)。MALT淋巴瘤患者均为Ⅰ~Ⅱ期、ECOG评分0~1分、无B症状, 患者均进行了手术切除, CR 4例, PR 1例。结论 PTL常见于合并桥本甲状腺炎的女性患者, 病理类型多为B细胞淋巴瘤, 治疗上以化疗为主, 放疗及手术为辅, 预后相对较好。

Objective To investigate the clinical characteristics,diagnosis,treatment,and prognosis of primary thyroid lymphoma(PTL).Methods A retrospective analysis was conducted on the clinical and pathological data of 34 newly diagnosed PTL patients admitted to Beijing Tongren Hospital from September 2010 to February 2023.The Kaplan-Meier survival curve and Log-rank test were used for survival analysis,and the Cox regression model was applied for univariate analysis of prognostic factors.Results All 34 PTL patients presented with cervical mass as the initial clinical manifestation.There were 9 males and 25 females.The pathological diagnosis was diffuse large B-cell lymphoma(DLBCL)in 29 patients and mucosa-associated lymphoid tissue(MALT)lymphoma in 5 patients.Among the DLBCL patients,6 had B symptoms,17 had an Eastern Cooperative Oncology Group(ECOG)score of≥2,the Ann Arbor staging was stageⅠ-Ⅱin 21 cases and stageⅢ-Ⅳin 8 cases,the tumor diameter was≥10 cm in 4 cases,and 14 had concurrent Hashimoto thyroiditis;27 cases received chemotherapy,with 21 cases achieving complete remission(CR),2 cases partial remission(PR),and 6 cases of disease progression;the 5-year progression-free survival and overall survival rates were 78.9%and 77.4%,respectively;univariate survival analysis showed that B symptoms,tumor diameter≥10 cm,and Ann Arbor stageⅢ-Ⅳwere significant factors affecting patient prognosis(P<0.05).MALT lymphoma patients were all in stagesⅠ-Ⅱ,had an ECOG score of 0-1,and were without B symptoms.All patients underwent surgical resection,with 4 cases achieving CR and 1 case PR.Conclusion PTL is more common in females with concurrent Hashimoto thyroiditis,with the majority of pathological types being B-cell lymphoma.The main treatment is chemotherapy,supplemented by radiotherapy and surgery,and the prognosis is relatively favorable.