头颈部结外非霍奇金淋巴瘤的REAL分类和治疗方式选择

REAL classification and selection of treatment modality for head and neck extranodal non-Hodgkin' s lymphomas

目的作者应用修正的欧美淋巴瘤(revised European and American Iymphoma,REAL)分类法对咽鼻头颈早期结外非霍奇金淋巴瘤(non—Hodgkin's Iymphoma,NHL)分类,并分析了其组织病理学分类和临床特点间的关系,试图评估这一新的修正分类法在选择治疗方式中的价值。方法 1980—1995年间经组织病理确诊为咽鼻头颈Ⅰ和Ⅱ期结外NHL患者共128例,均进行了治疗。对其中的108例可用标本进行了分析,其临床分期60例为Ⅰ期,48例为Ⅱ期。其中13例单做了放疗,34例做了强力的联合化疗,61例进行了化疗加放疗。结果组织病理分类36例为结外边缘性B细胞淋巴瘤,51例为弥漫性大B细胞淋巴瘤,9例为周围性T/NK细胞淋巴瘤,12例为其它NHL,所有患者其5年总生存率达75%。证实结外边缘区B细胞淋巴瘤或其他低度恶性B细胞淋巴瘤,较其他的淋巴瘤生存率为高,周围性T/NK淋巴瘤患者生存率最低。结论 REAL分类法可较准确地反应NHL患者的预后。结果提示:应用REAL分类法有助于选择NHL患者适当的治疗方式。

Purpose The revised European and American lymphoma( REAL) classification, was used to investigated the relationship between the clinical characteristics and histopathological classification in an attempt to evaluate the usefulness of this new classification system in selecting treatment modalities. Methods 108 specimens of 128 patients with histologically confirmed stages Ⅰ and Ⅱ NHL of pharynx, nose, head-and-neck extranodal regions were retrospectively analyzed. Sixty patients were at stage Ⅰ , and 48 were at stage Ⅱ diseases. All but 13 had received radiotherapy, 34 patients were treated with intensive combination chemotherapy, 61 patients were treated with both chemotherapy and radiation therapy. Results There were 36 extranodal marginal-zone B-cell lymphomas, 51 diffuse large B-cell lymphomas, 9 peripheral T/NK-cell lymphomas, and 12 others. The 5-year survival rates for all patients were 75% . Patients with extranodal marginal-zone B-cell lymphoma or other low-grade B-cell lymphomas were proved to demonstrate higher survival rates than those with other lymphomas, while patients with peripheral T/NK lymphomas showed the lowest survival rate. Conclusion The REAL classification accurately indicated the prognosis of patients with NHL.These results suggest that this classification is helped in selecting appropriate treatment modalities.