原发扁桃体非霍奇金淋巴瘤89例临床分析

背景与目的：扁桃体是原发头颈部非霍奇金淋巴瘤（non-Hodgkin’s lymphoma,NHL）的最常见部位。本研究主要分析和总结原发扁桃体NHL的临床特点及治疗预后,探讨进一步改善预后和治疗后生存质量的可能途径。方法：回顾性分析1990年5月至2003年1月,89例初治原发扁桃体NHL患者的临床资料。按照改良的欧洲．美国淋巴瘤和WHO淋巴瘤分类原则进行病理分类。根据AnnArbor标准进行分期。Ⅰ期和Ⅱ期患者主要接受放化疗联合治疗,Ⅲ期和Ⅳ期患者以化疗为主。结果：89例患者中弥漫大B细胞型60例（67％）,外周T细胞型11例（12％）,惰性淋巴瘤5例（6％）,间变大T细胞型和T淋巴母细胞型各1例,未明确分类11例（12％）。Ⅰ期和Ⅱ期患者8l例（91％）,其中58例（72％）为放化疗联合治疗,19例（23％）为单纯放疗,3例（4％）为单纯化疗,1例（1％）为放化疗联合美罗华治疗。全组患者5年总生存率和无病生存率均为80％,Ⅰ期和Ⅱ期患者的5年生存率为84％。早期患者的生存率与原发耐药、复发和国际预后指数（internationalprognostic index,IPI）评分有显著性相关;而性别、年龄、病理类型、B症状、是否有巨块等对生存率均无显著性影响。结论：原发于扁桃体的NHL绝大部分为Ⅰ期和Ⅱ期的早期患者．因此预后较好。病理类型以弥漫大B细胞型最为多见。Cox回归分析显示在早期患者中原发耐药、复发和IPI〉1是影响预后的主要因素。

Clinical features of 89 patients with primary non-Hodgkin's lymphoma of the tonsil

BACKGROUND & OBJECTIVE: Head and neck lymphoma develops predominantly in the tonsil. This study was to investigate the clinical features of primary non-Hodgkin's lymphoma (NHL) of the tonsil, and to explore possible ways to improve the prognosis and quality of life of the patients after treatment. METHODS: Clinical data of 89 naive patients with NHL of the tonsil, treated from May 1990 to Jan. 2003, were retrospectively reviewed. All patients were confirmed pathologically and classified according to revised European-American Lymphoid Neoplasms and World Health Organization Classification, and staged according to the Ann Arbor classification. Stage I-II patients received radiochemotherapy-predominant treatment, whereas stage III-IV patients received chemotherapy-predominant treatment. RESULTS: Of the 89 cases, 60 (67%) were diffuse large B-cell subtype, 11 (12%) were peripheral T-cell subtype, 5 (6%) were indolent lymphoma, 1 was anaplastic large T-cell lymphoma, and 1 was T lymphoblastic lymphoma; 81 (91%) were stage I-II disease. Of the 89 patients, 58 (72%) received radiochemotherapy, 19 (21%) received radiotherapy alone, 3 received chemotherapy alone, and 1 received radiochemotherapy combined with rituximab. The 5-year overall survival rate was 80%, that of stage I-II patients was 84%. Cox regression multivariate analysis showed that the survival rate was correlated to the value of international prognostic index (IPI), and whether the patient had primary refractory or relapsed disease, but was not correlated to sex, age, pathologic subtype, B symptoms, and bulky disease. CONCLUSIONS: Most patients with NHL of the tonsil are at early stages, with good prognosis. Diffuse large B-cell lymphoma is the most common pathologic subtype. Primary refractory, relapse, and IPI>1 are independent prognostic factors.