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目的 探讨原发性甲状腺非何杰金氏淋巴瘤(PTL)临床特点、诊断措施,治疗的选择及影响局部控制和预后因素。方法 1 972年1月～2 0 0 2年1 2月我院收治PTL 4 3例,对其临床表现特点及治疗结果进行分析。统计应用SPSS 1 0中的卡方检验、寿命表法、logrank检验及COX回归模型。结果 PTL肿瘤发展时,首先侵犯甲状腺周围的颈内淋巴结,低度恶性PTL无1例发展为高度恶性。总的5年、1 0年生存率分别为78%、71 %,5年、1 0年无瘤生存率分别为78%、78%;死于肿瘤7例,均为Ⅱ期以上,2例有B症状(2 /3) ,4例为弥漫大B细胞淋巴瘤(DLBCL ,4 /5 ) ,COX回归多因素分析示病理类型、颈部有淋巴结转移、分期及全身转移显著影响患者的生存期(P <0 .0 0 1 ) ,病程的长短也影响PTL的预后(P =0 .0 4 9)。局部复发9例,均为单纯手术者(9/1 1 ) ,B症状及治疗方案对肿瘤局部控制有影响(P <0 .0 0 1 ,P =0 .0 0 2 )。结论 PTL是预后较好的一组淋巴瘤。手术的作用明确病理诊断及分类。建议病理类型为粘膜相关淋巴细胞型结外边缘区B细胞淋巴瘤(MZL)和滤泡性淋巴瘤(FL)的IEA单纯术后放射治疗,ⅡEA以上可行术后放疗+化疗。而对于有B症状或/和高度恶性的PTL则应以化疗为主,完全缓解后可考虑局部放疗。
Objective To investigate the clinical features, diagnosis and treatment of primary thyroid non-Hodgkin’s lymphoma (PTL), the choice of treatment and the factors influencing local control and prognosis. Methods January 1972 January to February 2002 in our hospital admitted to PTL 43 cases, the clinical features and treatment results were analyzed. Statistical application of SPSS 10 in the chi-square test, life table method, logrank test and COX regression model. Results PTL tumor development, the first violation of the thyroid around the cervical lymph nodes, low grade malignant PTL without a case of the development of highly malignant. The overall 5-year, 10-year survival rates were 78%, 71%, 5 years, 10 year disease-free survival rates were 78%, 78%; 7 died of tumor, were more than Ⅱ, 2 B symptoms (2/3), 4 cases of diffuse large B cell lymphoma (DLBCL, 4/5), COX regression multivariate analysis showed pathological types, neck lymph node metastasis, staging and systemic metastasis significantly affect the survival of patients The duration of disease also affected the prognosis of PTL (P = 0.0409). Local recurrence in 9 cases, were simple surgery (9/1 1), B symptoms and treatment of local tumor control have an impact (P <0. 01, P = .0 0 2). Conclusions PTL is a good prognosis group of lymphoma. The role of surgery clear pathological diagnosis and classification. Suggested pathological types of mucosa associated lymphoid extranodal marginal zone B cell lymphoma (MZL) and follicular lymphoma (FL) IEA simple postoperative radiotherapy, ⅡEA more feasible postoperative radiotherapy + chemotherapy. For patients with B symptoms and / or highly malignant PTL, chemotherapy should be the mainstay and local radiotherapy should be considered after complete remission.