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目的探讨原发性甲状腺非何杰金淋巴瘤(PTL)的临床生物学特点及临床意义。方法1972年1月至2002年12月我院共收治PTL43例,对其临床表现及预后进行分析,观察PTL肿瘤发展规律及影响预后的因素。应用SPSS10软件,采用卡方检验、寿命表法、Kaplan-Meier法及COX风险回归模型进行统计学分析。结果患者5、10年总生存率分别为78%和71%,5、10年无瘤生存率均为78%。单因素及多因素分析显示,病理类型、颈部淋巴结转移、分期和B症状(即全身症状,如发热、盗汗、体重减轻等)显著影响患者的生存期(P<0.001),病程长短也影响PTL的预后(P=0.049),年龄不是影响预后的因素。PTL病情进展时,肿瘤沿甲状腺淋巴引流区扩散,未发现跳跃性。两叶以上病灶者颈内淋巴结转移率为50%(7/14例),显著高于单叶者的14%(4/29例,P<0.05)。有淋巴结转移者的远处转移率及肿瘤相关死亡率高于无淋巴结转移者(P值均<0.01)。弥漫性大B细胞淋巴瘤(DLBCL)患者的淋巴结转移率、远处转移率、肿瘤相关死亡率高于滤泡型淋巴瘤(FL)和黏膜相关淋巴细胞型结外边缘区B细胞淋巴瘤(MZL)患者(P<0.01)。未观察到低度恶性PTL转化为高度恶性淋巴瘤。MZL和FLⅠ期患者无论采用何种治疗,均可获得长期生存;对不利预后因素(DLBCL、FLⅡ期以上和B症状)患者,给予以阿霉素为主的化疗方案,仍难以控制肿瘤的进展。结论PTL具有自己的临床生物特点和发展规律,根据其临床生物特性制定治疗策略较为恰当。
Objective To investigate the clinical features and clinical significance of primary thyroid non-Hodgkin’s lymphoma (PTL). Methods From January 1972 to December 2002, a total of 43 PTL cases were treated in our hospital. The clinical manifestations and prognosis of PTL were analyzed. The rules of PTL tumor development and the prognostic factors were analyzed. SPSS10 software was used for statistical analysis using chi-square test, life table method, Kaplan-Meier method and COX risk regression model. Results The 5-year and 10-year overall survival rates were 78% and 71%, respectively. The 5-year and 10-year tumor-free survival rates were 78%. Univariate and multivariate analysis showed that pathological type, cervical lymph node metastasis, staging and B symptoms (ie, systemic symptoms such as fever, night sweats, weight loss, etc.) significantly affected the survival of patients (P <0.001), duration of disease also affected Prognosis of PTL (P = 0.049), age is not a factor affecting the prognosis. When the progression of PTL progressed, the tumor spread along the lymphatic drainage area of the thyroid gland, and no jumping was found. The rate of cervical lymph node metastasis was more than 50% (7/14 cases) in patients with more than two lobes, which was significantly higher than that in patients with single lobe (4/29, P <0.05). The distant metastasis and tumor-related mortality in patients with lymph node metastasis were higher than those without lymph node metastasis (P <0.01). Patients with diffuse large B-cell lymphoma (DLBCL) had higher rates of lymph node metastasis, distant metastasis, and tumor-associated mortality than those with follicular lymphoma (FL) and mucosa-associated lymphoid extranodal marginal zone B-cell lymphoma MZL) patients (P <0.01). No low-grade malignancy was observed in PTL. Long-term survival is achieved regardless of the treatment used in patients with MZL and FLI, and adriamycin-based chemotherapy in patients with adverse prognostic factors (DLBCL, FL stage II and above) is still difficult to control for tumor progression . Conclusion PTL has its own clinical biological characteristics and development of law, according to the clinical biological characteristics of the treatment strategy is more appropriate.