原发性睾丸非霍奇金淋巴瘤的临床特征和疗效分析*

目的:分析单中心的原发性睾丸非霍奇金淋巴瘤患者的临床特征和治疗效果。方法:回顾复习了2001年1 月至2008年12月间福建医科大学附属协和医院26例原发性睾丸非霍奇金淋巴瘤患者的临床资料，包括年龄、病变受累部位、Ann-Arbor分期、B 症状、血清乳酸脱氢酶、血清β 2 微球蛋白、国际预后指数以及治疗方法。电话随访患者的生存情况，统计分析生存曲线和治疗效果。随访截止时间是2009年12月31日。结果:患者的中位生存时间是38个月。16例患者治疗后获完全缓解；3 例部分缓解；2 例疾病稳定状态；4 例治疗期间疾病进展。16例完全缓解的患者中，中位生存时间为61个月，第1、2、5 年总生存率分别是88% 、73% 、62% ，第1、2、5 年无进展生存率分别是85% 、58% 、35% 。中低危IPI 的患者预后明显好于高危IPI 的患者，前者中位生存时间是48个月（95% CI:34～62），而后者中位生存时间仅14个月（95% CI:11～17）。手术切除后联合化疗1 年总生存率和无进展生存率均为100% ，而单纯局部照射治疗1 年总生存率和无进展生存率分别是67% 和33% 。采用含利妥昔单抗的化疗为基础的综合治疗，5 年OS为50% ，而无利妥昔单抗的只有30%（P=0.335）。 结论:原发性睾丸非霍奇金淋巴瘤没有明显的生存平台期，中低级国际预后指数的患者疗效较好。手术切除后联合化疗早期效果明显，单纯局部放射治疗效果差。采用含利妥昔单抗的化疗为基础的综合治疗可以提高患者总生存情况。 

Clinical Features of Primary Testicular Non-Hodgkin's Lymphoma and Treatment Efficacy

Objective:This study was done to assess characteristics and curative effects seen in patients with primary testicular non-Hodgkin's lymphoma (PTL) in a single clinic. Methods:Clinical data of the 26PTL patients admitted to our hospital during the period from January 2001to December 2008were reviewed, including the age, location, Ann-Arbor stag -ing, B-symptoms, serum levels of lactate dehydrogenase, serum levels of β 2-microglobulin, and International Prognostic In -dex (IPI). Treatment methods were included as well. The status of the patients was obtained through telephone calls and statistical analysis of the survival curve and therapeutic effect was conducted using software. Follow-up continued until De-cember 31, 2009. Results: Median survival time of the patients was38months. Complete remission (CR) occurred in 16of the cases, partial remission (PR) occurred in 3 cases, and stable disease (SD) occurred in2 cases. Four of the cases expe-rienced progression of disease (PD) during the treatment. In the 16cases with CR, median survival time was 61months, the 1-, 2- and 5-year overall survival (OS) rates were 88%,73% and 62%, and the 1-, 2- and 5-year progression-free surviv -al (PFS) rates were 85%,58% and 35%, respectively. The prognosis was obviously better in the patients with moderately low IPI than in those with high IPI. The median survival time was 48months in the patients with low IPI (95% CI:34- 62), but was only 14months in the patients with high IPI (95%CI:11-17). The 1-year OS and PFS rates were both 100 % in the patients with postoperative chemotherapy and were67% and 33%, respectively, in those patients treated with local irradia-tion (scrotal radiotherapy) alone. The 5-year OS was 50% in the patients treated with rituximab-based combined chemother-apy, but was 30% in those undergoing chemotherapy without rituximab (P=0.335 ). Conclusion:The curative effect seen in the patients with moderately low IPI is better compared to those with high IPI. Patients that receive early postoperative chemotherapy experience a better therapeutic effect. However, the curative effect of simple local irradiation alone is poor. Surgery plus rituximab-based chemotherapy improves the OS rate.