Ha C S, Shadle K M, Medeiros L J, Wilder R B, Hess M A, Cabanillas F, Cox J D
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
Cancer. 2001 Feb 15;91(4):629-35.
The current study was undertaken to define the natural history and patterns of failure of localized non-Hodgkin lymphoma (NHL) involving the thyroid gland.
A retrospective review of 51 patients with Ann Arbor Stage I or II NHL involving the thyroid gland was performed. The median age of the patients was 59 years. There were 33 females. There were 21 patients with Stage I disease and 30 patients with Stage II disease. The International Prognostic Index (IPI) was known for 43 patients (it was 0 in 16 patients and > or = 1 in 27 patients). Fifteen patients had mediastinal involvement. Four patients underwent thyroidectomy, 18 patients received radiation therapy, 5 patients received chemotherapy, and 24 patients received combined modality therapy (CMT) with chemotherapy and radiation therapy. Treatment modality, patient gender, IPI, disease stage, and mediastinal involvement were examined for significance with regard to overall survival (OS) and failure free survival (FFS).
The 5-year OS and FFS rates were 64% and 76%, respectively. The 5-year FFS rates by treatment regimen were 76% for radiation therapy, 50% for chemotherapy, and 91% for CMT (P = 0.15). IPI was found to be the only significant predictor of OS. The 5-year OS rates were 86% and 50%, respectively, for IPIs of 0 and > or = 1 (P = 0.02). None of the 5 variables were found to correlate significantly with FFS, although the 5-year FFS rates were 93% and 68%, respectively, for IPIs of 0 and > or = 1 (P = 0.08). Eleven patients failed treatment. Nine patients had a component of distant failure across the diaphragm.
The prognosis of patients with localized NHL involving the thyroid gland appears to be very good, especially when CMT is used. Distant recurrences appear to account for the majority of treatment failures. The IPI was found to be a significant prognostic factor for OS and a marginal one for FFS.
开展本研究以明确累及甲状腺的局限性非霍奇金淋巴瘤（NHL）的自然病程及失败模式。
对51例Ann Arbor I期或II期累及甲状腺的NHL患者进行回顾性分析。患者的中位年龄为59岁。其中女性33例。I期疾病患者21例，II期疾病患者30例。43例患者的国际预后指数（IPI）已知（16例患者为0，27例患者≥1）。15例患者有纵隔受累。4例患者接受了甲状腺切除术，18例患者接受了放射治疗，5例患者接受了化疗，24例患者接受了化疗联合放射治疗的综合治疗模式（CMT）。对治疗方式、患者性别、IPI、疾病分期和纵隔受累情况在总生存期（OS）和无失败生存期（FFS）方面的显著性进行了检查。
5年OS率和FFS率分别为64%和76%。按治疗方案的5年FFS率分别为：放射治疗76%，化疗50%，CMT 91%（P = 0.15）。发现IPI是OS的唯一显著预测因素。IPI为0和≥1的患者5年OS率分别为86%和50%（P = 0.02）。尽管IPI为0和≥1的患者5年FFS率分别为93%和68%（P = 0.08），但未发现这5个变量中的任何一个与FFS有显著相关性。11例患者治疗失败。9例患者有膈上远处失败成分。
累及甲状腺的局限性NHL患者的预后似乎非常好，尤其是采用CMT时。远处复发似乎是治疗失败的主要原因。发现IPI是OS的显著预后因素，对FFS是一个边缘性因素。
