Surbone A, Longo D L, DeVita V T, Ihde D C, Duffey P L, Jaffe E S, Solomon D, Hubbard S M, Young R C
Medicine Branch, National Cancer Institute, Bethesda, MD 20892.
J Clin Oncol. 1988 Dec;6(12):1832-7. doi: 10.1200/JCO.1988.6.12.1832.
When patients with aggressive lymphoma present with intraabdominal disease, a stable residual mass is frequently detected radiographically at the time of the clinical complete remission. To discern the optimal management for this clinical problem, we reviewed 241 patients with aggressive lymphoma treated at the National Cancer Institute (NCI) from 1977 to 1986. Seventy-two/241 patients (30%) had an abdominal mass at diagnosis and 29/72 (40%) were left with a radiographically detectable residual mass at clinical complete remission. The likelihood of a residual mass was much higher for patients with bulky disease (P2 less than .0003) (two-tailed test [P2]). Twenty-nine patients had radiologically stable residual masses after therapy, and of 22 (76%) with pathologic evaluations, 21 had negative specimens (95%) and one was positive (5%). None of the patients with negative pathologic evaluation has relapsed in the abdominal site (median follow-up, 31 months). Seven patients were observed clinically without laparotomy: five are alive, without evidence of disease, at 2 to 9 years; two relapsed with disseminated disease within 2 months of chemotherapy. Initial tumor size and size of the residual mass did not correlate with residual disease, since residual masses identified by radiographic examination did not usually harbor viable lymphoma cells. Aspiration cytology was negative for residual tumor in 15/16 cases. One negative result was not confirmed at laparotomy, presumably due to sampling error. The one positive aspiration was followed by a negative laparotomy, possibly due to subsequent tumor necrosis. Restaging laparotomy has a low yield. In most patients with aggressive lymphoma who have otherwise completely responded to carefully administered full-dose combination chemotherapy, stable residual abdominal masses can be closely followed clinically without surgical exploration.
侵袭性淋巴瘤患者出现腹腔内病变时，在临床完全缓解时经影像学检查常可发现稳定的残留肿块。为了明确针对这一临床问题的最佳处理方法，我们回顾了1977年至1986年在国立癌症研究所（NCI）接受治疗的241例侵袭性淋巴瘤患者。72/241例患者（30%）在诊断时有腹部肿块，29/72例（40%）在临床完全缓解时经影像学检查仍有可检测到的残留肿块。肿块较大的患者出现残留肿块的可能性要高得多（P2＜0.0003）（双侧检验[P2]）。29例患者治疗后有影像学稳定的残留肿块，在22例（76%）接受病理评估的患者中，21例标本为阴性（95%），1例为阳性（5%）。病理评估为阴性的患者中，无一例在腹部复发（中位随访31个月）。7例患者未行剖腹手术而进行临床观察：5例存活，2至9年无疾病证据；2例在化疗后2个月内出现播散性疾病复发。初始肿瘤大小和残留肿块大小与残留疾病无关，因为经影像学检查发现的残留肿块通常不含存活的淋巴瘤细胞。16例中有15例残留肿瘤的细针穿刺细胞学检查为阴性。1例阴性结果在剖腹手术时未得到证实，可能是由于取样误差。1例细针穿刺阳性结果随后剖腹手术为阴性，可能是由于随后肿瘤坏死。再次分期剖腹手术的阳性率较低。对于大多数侵袭性淋巴瘤患者，若已对精心给予的全剂量联合化疗完全缓解，临床上可密切观察稳定的残留腹部肿块，无需进行手术探查。
