Tupchong L, Hughes F, Harmer C L
Int J Radiat Oncol Biol Phys. 1986 Oct;12(10):1813-21. doi: 10.1016/0360-3016(86)90324-x.
This study analyzes the results of 46 cases of biopsy-proven primary lymphoma of the thyroid, localized at diagnosis and treated at the Royal Marsden Hospital between 1948-1980. In all cases, disease was limited to the thyroid and cervical lymph nodes. There were 43 females and 3 males, with a mean age of 64.4 years (median 66 years; range 17-86). A short history (less than 3 months) of a neck mass and local compressive symptoms was the typical presentation. The majority of patients (91%) had adverse histologies, with diffuse histiocytic lymphomas being most common (78%). The overall crude 5-year survival rate was 40%, with 30% of patients surviving beyond 10 years. Disease-free and overall survival were virtually identical, indicating the ineffectiveness of salvage therapy. The important prognostic factors were: size of tumor, fixation, extra-capsular extension, and retrosternal involvement. Survival was not correlated with age, sex, histology, thyroid status, or stage of disease, as defined by the Ann Arbor classification. Patients who had total macroscopic removal of tumor had the highest rate of local control and long survival (p less than 0.005). No significant difference was seen between lobectomy, subtotal or total thyroidectomy, but 7 of 9 long-term survivors (58-129 months) have had total thyroidectomy. A radiotherapy dose to the tumor, of at least 40 Gy, was required to produce consistent local control in patients with unresected disease. The majority of patients who died had generalized disease. Only 52% of these patients were free of local recurrence. In view of the frequency of occult disseminated disease, adjuvant chemotherapy is one recommendation for patients with poor prognostic factors. For optimal local control, complete surgical eradication is recommended followed by high-dose local radiotherapy. The use of aggressive cytoreductive chemotherapy prior to radiotherapy is a possible alternative option which needs to be explored.
本研究分析了46例经活检证实的原发性甲状腺淋巴瘤的结果，这些病例在诊断时局限于甲状腺，并于1948年至1980年间在皇家马斯登医院接受治疗。所有病例中，疾病均局限于甲状腺和颈部淋巴结。有43名女性和3名男性，平均年龄为64.4岁（中位数66岁；范围17 - 86岁）。颈部肿块和局部压迫症状的短病程（少于3个月）是典型表现。大多数患者（91%）组织学表现不良，弥漫性组织细胞淋巴瘤最为常见（78%）。总体粗5年生存率为40%，30%的患者存活超过10年。无病生存率和总生存率几乎相同，表明挽救治疗无效。重要的预后因素为：肿瘤大小、固定情况、包膜外扩展和胸骨后受累情况。生存率与年龄、性别、组织学、甲状腺状态或根据安阿伯分类定义的疾病分期无关。肿瘤大体完全切除的患者局部控制率最高且生存期长（p < 0.005）。叶切除术、次全或全甲状腺切除术之间未见显著差异，但9名长期存活者（58 - 129个月）中有7例行全甲状腺切除术。对于未切除疾病的患者，需要至少40 Gy的肿瘤放疗剂量才能产生一致的局部控制。大多数死亡患者有全身性疾病。这些患者中只有52%无局部复发。鉴于隐匿性播散性疾病的发生率，对于预后不良因素的患者，辅助化疗是一种推荐。为实现最佳局部控制，建议完全手术根除，随后进行高剂量局部放疗。放疗前使用积极的细胞减灭化疗是一个可能的替代选择，有待探索。
