135例鼻腔非霍杰金淋巴瘤的治疗与预后分析

目的 评价化疗、放疗、放疗＋化疗及自体外周血干细胞移植（APBSCT）联合全身放疗（TBI）四种治疗方法对原发鼻腔非霍奇金淋巴瘤的疗效,并对影响预后的因素进行分析.方法 20年间收治的原发鼻腔非霍奇金淋巴瘤135例全部经病理证实,其中T细胞来源122例,B细胞来源12例,NK细胞来源1例.放疗主野为鼻前凸字野,辅单或双侧耳前野,累及口咽者先用面颈联合野.鼻腔靶区中位剂量56.0Gy（35.2～75.5Gy）.TBI组剂量为8Gy,有2例原发灶加量30Gy.辅助化疗在放疗前、中、后进行或单纯化疗,方案为COP、COPP、COMP、CHOP、COBDP.用Cox模型对影响预后的多因素进行分析.结果 单化组、单放组、放加化组及APBSCT联合TBI组局部控制率分别为12%、69%、76%、83%（P=0.057）,5年总生存率分别为9%、52%、63%、83%（P=0.032）.除Ann-Arbor分期外,局部侵犯范围、治疗方法也是影响预后的主要因素,而病理类型、性别、年龄及全身症状等因素对预后影响不大.结论 放化联合的生存率优于单纯放疗.在Ann Arbor分期的基础上依照局部侵犯部位进一步分区,对评价预后有意义.对于原发鼻腔非霍奇金淋巴瘤的治疗有条件者可试用APBSCT联合TBI.     

Ⅰ期和Ⅱ期原发于头颈部非霍奇金淋巴瘤预后因素分析

目的:分析影响Ⅰ期和Ⅱ期原发于头颈部非霍奇金淋巴瘤预后因素,寻求合理的治疗方案。方法:1994年6月至2000年6月共收治Ⅰ期和Ⅱ期原发于头颈部非霍奇金淋巴瘤54例,分别采用单纯放疗,放疗 化疗和单纯化疗。放疗多采用局部野或局部扩大野照射,原发部位DT50Gy~55Gy,邻近一站淋巴结区预防剂量DT45Gy。化疗用CHOP方案,化疗4~6周期。结果:全组5年生存率为64%,其中Ⅰ期为75%,Ⅱ期为47%(P<0.05)。低度恶性、中度恶性、高度恶性患者5年生存率分别为70%、54%、39%,其中低度恶性组5年生存率明显高于高度恶性组(P<0.05)。放疗 化疗组5年生存率69%,明显高于其它二组(P<0.05)。单纯放疗及放疗 化疗治疗后局部控制率达92%,明显高于单纯化疗组(P<0.05)。单纯化疗组治疗后局部复发率较高,达37.5%。结论:临床分期、病理类型及治疗方法是影响其预后的主要因素。单纯化疗组治疗后局部复发率较高,提示放疗在早期非霍奇金淋巴瘤治疗中还是占有比较重要的地位,不能用单纯化疗取代放疗,有计划的放疗 化疗是提高局部控制率和生存率的关键。     

Ⅰ期和Ⅱ期原发于头颈部非霍奇金淋巴瘤预后因素分析

目的:分析影响Ⅰ期和Ⅱ期原发于头颈部非霍奇金淋巴瘤预后因素,寻求合理的治疗方案.方法:1994年6月至2000年6月共收治Ⅰ期和Ⅱ期原发于头颈部非霍奇金淋巴瘤54例,分别采用单纯放疗,放疗+化疗和单纯化疗.放疗多采用局部野或局部扩大野照射,原发部位DT50Gy～55Gy,邻近一站淋巴结区预防剂量DT45Gy.化疗用CHOP方案,化疗4～6周期.结果:全组5年生存率为64%,其中Ⅰ期为75%,Ⅱ期为47%(P＜0.05).低度恶性、中度恶性、高度恶性患者5年生存率分别为70%、54%、39%,其中低度恶性组5年生存率明显高于高度恶性组(P＜0.05).放疗+化疗组5年生存率69%,明显高于其它二组(P＜0.05).单纯放疗及放疗+化疗治疗后局部控制率达92%,明显高于单纯化疗组(P＜0.05).单纯化疗组治疗后局部复发率较高,达37.5%.结论:临床分期、病理类型及治疗方法是影响其预后的主要因素.单纯化疗组治疗后局部复发率较高,提示放疗在早期非霍奇金淋巴瘤治疗中还是占有比较重要的地位,不能用单纯化疗取代放疗,有计划的放疗+化疗是提高局部控制率和生存率的关键.     

鼻腔非霍奇金淋巴瘤70例

目的评价原发鼻腔非霍奇金淋巴瘤（NHL）放疗和化疗的近期疗效,并对影响预后的因素进行分析。方法1993年1月至2002年12月收治的原发鼻腔NHL70例全部经病理证实,其中T细胞来源52例,B细胞来源2例,NK／T细胞来源16例。放疗主野为鼻前凸字形野,辅单或双侧耳前野,累及口咽者先用面颈联合野,放疗采用60^Co或直线加速器常规放射,2Gy／次。鼻腔靶区中位剂量54Gy（36～66Gy）。辅助化疗在放疗前、中、后进行或单纯化疗,方案为COP、CHOP、COBDP。用COX模型对影响预后的多因素进行分析。结果单化组、单放组、放加化组局部控制率分别为12．5％、66．7％、74．0％,5年总生存率分别为12．5％、50．0％、62．0％（P〈0．05）。首程治疗后的CR率是独立的预后因素,除Ann Arbor分期外,局部侵犯范围、发热、治疗方法也是影响预后的主要因素,而病理类型、性别、年龄及全身症状等因素对预后影响不大。结论放化疗联合治疗原发鼻腔NHL的生存率优于单纯放疗和单纯化疗。对于原发鼻腔NHL的治疗有条件者可试用自体干细胞移植。     

咽淋巴环非霍奇金淋巴瘤38例分析

目的：探讨咽淋巴环非霍奇金淋巴瘤（Non-Hodgkin Lymphoma)的临床特点、治疗及预后。方法：采用“三明治”法,即化疗－放疗－化疗,对38例原发于咽淋巴环的NHL患进行治疗。结果：近期疗效中CR28例（71．1％）,PR7例（18．4％）。远期疗效：3年和5年生存率分别为81．6％和68．4％。结论：对咽淋巴环NHL,“三明治”法能明显提高3年和5年生存率,并减少远处转移及复发。     

化、放疗治疗Ⅰ、Ⅱ期咽淋巴环NHL(附25例临床分析)

咽淋巴环非霍奇金氏淋巴瘤（ＮＨＬ）常规首选放疗，我们自１９８０～１９９０年对收治的２５例原发于咽淋巴环Ⅰ、Ⅱ期ＮＨＬ的病人，采用化疗－放疗－化疗即“三明治”法，亦取得可喜的近期及远期疗效。所有２５例均经病理证实，按照ＡｎｎＡｒｂｏｒ临床分期，Ⅰ期８例，Ⅱ期１７例。近期疗效：完全缓解（ＣＲ）２０例，部分缓解（ＰＲ）３例。远期疗效，其１、３、５年生存率分别为８８％、７６％、６４％，高于单纯放疗。本文阐明了化疗的作用及意义，并结合临床观察结果，对咽淋巴环ＮＨＬ的预后因素进行了分析     

Ⅰ,Ⅱ期咽淋巴环非何杰金淋巴瘤139例临床治疗分析

探讨提高Ⅰ，Ⅱ期咽淋巴环非何杰金淋巴瘤疗铲的治疗方式。方法：回顾性分析了Ⅰ，Ⅱ期咽淋巴环非何杰金淋巴瘤１３９例，分为单纯放疗，放疗加化疗，放疗加化疗三组，比较治疗结果。结果：－Ⅰ期三种治疗方式的５年生存率分别为７２．２％，４３．７％和６６．７％。统计学处理无差异。Ⅱ期放疗加化疗４－６周期优于放疗加化疗１－３周期，优于单纯放疗，５年生存率分别为６４．０％，３５．６％和２６．９％。结论：Ⅰ期以放疗为主     

60例Ⅰ、Ⅱ期咽淋巴环非何杰金淋巴瘤疗效分析

198 6年 1月至 1 991年 8月治疗 6 0例原发于咽淋巴环恶性淋巴瘤。首选放射治疗 ,照射原发灶及全颈淋巴引流区 ,照射剂量 4 5Gy以上 ,部分病例放疗前或放疗后辅助化疗。全组 3,5年生存率分别为 6 8.33% ,4 8.72 %。影响预后因素主要为期别 ,全身症状及病理类型 ,与发生部位关系不大。治疗失败的主要原因是病情进展 ,尤其是膈下侵犯。     

Ⅰ/Ⅱ期乳腺原发非霍奇金淋巴瘤治疗结果及预后分析

背景与目的：乳腺原发非霍奇金淋巴瘤是一种罕见的淋巴瘤，文献报道病例数较少，治疗及预后因素值得探讨。本研究回顾性分析Ⅰ/Ⅱ期乳腺原发恶性淋巴瘤的临床特点、治疗疗效及预后因素。方法：收集1981年至2001年本院收治的25例Ⅰ/Ⅱ期乳腺原发非霍奇金淋巴瘤患者资料，患者均为女性，其中ⅠE期16例，ⅡE期9例。中位年龄42岁（范围：23～74岁）。全部病例经病理证实。23例患者行局部肿块切除术或活检术，2例行乳腺根治切除术。23例患者术后接受辅助化疗，14例患者在术后接受辅助放疗。结果：中位随访时间为5年，全组5年、10年、15年的总生存率分别为69．1％、55．3％．36．9％；无瘤生存率分别为47．5％、34．6％、34．6％。COX单因素分析发现分期、淋巴瘤国际预后指数（IPI）、乳酸脱氢酶（LDH）和辅助放疗对无瘤生存率的影响具有统计学意义。结论：总结本组Ⅰ/Ⅱ期乳腺原发非霍奇金淋巴瘤的特点，发现患者以中年居多，症状以单侧的乳房肿块为主，常伴有LDH升高，病理类型以弥漫性B细胞型为主。IPI是有价值的预后因素。术后联合放、化疗是较合理的治疗方案，但如何进一步降低远处播散是今后要解决的问题。     

Ⅰ、Ⅱ期咽淋巴环非何杰金淋巴瘤139例临床治疗分析

目的：探讨提高Ⅰ、Ⅱ期咽淋巴环非何杰金林巴瘤疗效的治疗方式。方法：回顾性分析Ⅰ、Ⅱ期咽淋巴环非何杰金淋巴瘤139例。分为单纯放疗，放疗加化疗（1～3周期），放疗加化疗（4～6周期）三组，比较治疗结果。结果：Ⅰ期三种治疗方式的5年生存率分别为72．2％、43．7％和66.7％。统计学处理无差异（P＞0.05）。Ⅱ期放疗加化疗4～6周期优于放疗加化疗1～3周期（P＜0．05），优于单纯放疗P＜0．61），5年生存率分别为64.0%、35.6％和26.9％。结论：Ⅰ期以放疗为主，Ⅱ期行放疗加化疗（4～6周期）的综合治疗能提高疗效。     

Former cancer patients as counselors of newly diagnosed cancer patients

This study tested the hypothesis that counseling of newly diagnosed cancer patients by former cancer patients will increase the use of coping strategies and reduce psychological stress beyond what can be accomplished by just counseling from professional staff. Thirty-two newly diagnosed patients in a gynecologic oncology service were subjects in this study. All subjects received supportive services from professionals assigned to the service. Control group patients received just the professional support program, while the experimental group patients received professional support plus additional counseling by former cancer patients that emphasized four coping strategies characteristic of patients who have adapted well to cancer. Results 6 and 12 weeks after entering the study showed no statistically significant differences in emotional status between experimental and control groups and only one significant difference in coping behaviors that was opposite to what was predicted. The findings do not support the hypothesis.     

Communicating with patients

The effective clinician realizes that more than accurate factual information is necessary for effective communication. The responsibility for this communication is the doctor's. Herein is an examination of some of the major areas of contention that, if acknowledged by the physician, can lead to better communication with the patient.     

Survival experience of black patients and white patients with bladder carcinoma

BACKGROUND: Blacks are less likely than whites to develop bladder carcinoma. However, once they are diagnosed, black patients experience poorer survival. The authors investigated which factors were related to survival differences in black patients and white patients with bladder carcinoma stratified by extent of disease. METHODS: A population-based cohort of black patients with bladder carcinoma and a random sample of frequency-matched white patients with bladder carcinoma, stratified by age and gender, were identified through cancer registry systems in Atlanta, New Orleans, and San Francisco/Oakland. Patients had no previous cancer history and were ages 20-79 years at the time they were diagnosed with bladder carcinoma in 1985-1987. Medical records were reviewed at initial diagnosis, and 77% of patients were interviewed. Tumor grade, T classification, and other variables, including age, socioeconomic position, symptom duration, smoking history, and comorbidities, were recorded. Survival of black patients and white patients by extent of disease was modeled using Cox regression analysis. RESULTS: A greater proportion of black patients had histologic types of tumors that were associated with poorer survival. Among those with pure urothelial carcinoma, black patients had greater extent of disease at the time of diagnosis. Within specific extent-of-disease categories, there was some evidence of poorer survival for black patients with T2 tumors and strong evidence of poorer survival among those with T3 tumors compared with white patients. Black patients with muscle-invasive carcinoma who died within 6 months of diagnosis tended to present with life-threatening symptoms. Black patients and white patients did not differ with respect to diagnostic tests performed or therapy given. CONCLUSIONS: Black patients with bladder carcinoma had poorer survival due to greater extent of disease at diagnosis and a higher proportion of more aggressive histologies compared with white patients. Within urothelial carcinomas, by extent of disease (clinical/pathologic stage) these black/white survival differences were limited to patients with muscle invasion (T2 and T3 tumors).