鼻腔、鼻咽部非霍奇金淋巴瘤患者的治疗与预后分析

目的 探讨鼻腔、鼻咽部不同细胞(B细胞、T细胞、NK/T细胞)来源的非霍奇金淋巴瘤(NHL)的临床特点及其与生存率的相关性,为该病的临床诊治提供参考.方法 回顾性分析2009年7月至2013年7月在本院确诊的33例鼻腔、鼻咽部NHL的临床资料并随访生存率,比较不同细胞来源、部位、治疗方案、临床分期等的生存率差异.结果 本组资料中男性17例,女性16例,以40~60岁为主(51.5%),以NK/T细胞最多见(16例,48.5%),伴B症状者13例(39.4%),被误诊者9例(27.3%),两次及以上活检明确诊断者9例(27.3%).原发部位为鼻咽部7例(21.2%),鼻腔26例(78.8%).根据Ann Arbor分期,Ⅰ/ⅡE期24例(72.7%),Ⅲ/ⅣE期9例(27.3%).全组估计中位生存时间42个月.单因素分析显示,不同原发部位(P=0.007)、患者年龄(P=0.031)与生存预后相关.多因素分析显示患者年龄是鼻腔、鼻咽部NHL的独立预后因素(P=0.018).不同细胞来源、治疗方案、B症状有无、Ann Arbor分期、误诊活检等分组比较,对生存率无明显影响.3例行放化疗加自体造血干细胞移植术的综合治疗患者,截止到末次随访时间均存活.结论 NHL发病无明显性别差异,好发于40~60岁,以NK/T细胞来源为主,预后较差;原发部位为鼻咽部者生存预后较原发于鼻腔者可能更差;患者年龄越大,预后越差.自体造血干细胞移植术可能值得进一步实践.

Treatment and survival analysis of patients with non-Hodgkin's lymphoma in the nasal cavity and nasopharynx

Objective To investigate the clinical characteristics, survival rate of patients with non-Hodgkin's lymphoma (NHL) in the nasal cavity and nasopharynx, then to provide the reference for its clinical diagnosis and treat-ment. Methods The clinical data of 33 patients with NHL in nasal cavity and nasopharyngeal confirmed in our hospital from July 2009 to July 2013 was retrospectively analyzed. The survival rate of patients with different cell sources, loca-tions, treatments, and clinical stages were compared. Results Among the 33 cases (17 males and 16 females), mainly 40~60 years old (51.5%), there were 16 cases (48.5%) derived from NK/T cell, 13 cases (39.4%) with B symptoms, 9 cases (27.3%) of misdiagnosis, and 9 cases (27.3%) confirmed by two or more times of biopsy. As for primary sites, 7 cases (21.2%) were in nasopharynx and 26 cases (78.8%) were in nasal cavity. For Ann Arbor staging, 24 cases (72.7%) were inⅠ/Ⅱand 9 cases (27.3%) in Ⅲ/Ⅳ. The median survival time was 42 months. Univariate analysis showed that different primary site (P=0.007), age (P=0.031) were correlated with survival, and multivariate analysis showed that age was an independent prognostic factors (P=0.018). Cell sources, treatments, whether with B symptoms, Ann Arbor stage,and misdiagnosis showed no significant effect on survival rate. The three patients undergoing radiotherapy and chemo-therapy combined with autologous hematopoietic stem cell transplantation were all alive at the end of the follow-up. Conclusion NHL shows no significant difference between gender, and is mainly observed in 40~60 years old, which is mainly derived from NK/T cell and results in poor prognosis. The prognosis of patients with NHL in the nasopharynx could be worse than that tin nasal cavity. The older the patients, the worse the prognosis. Autologous hematopoietic stem cell transplantation may be worthy of further practice.