Stroh E L, Besa P C, Cox J D, Fuller L M, Cabanillas F F
Department of Radiotherapy, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Cancer. 1995 May 1;75(9):2392-9. doi: 10.1002/1097-0142(19950501)75:9<2392::aid-cncr2820750932>3.0.co;2-y.
Primary lymphomas of the uterus or cervix are so rare that treatment series of single institutions consist of very small numbers of patients, making standard treatment difficult to define. The outcome of patients treated with a combination of chemotherapy and radiation therapy was analyzed for all but patients with the most advanced disease.
From 1976 to 1992, 16 patients received definitive treatment. Thirteen patients had intact uteri (group 1) and 3 presented with paracolpal lymphomas after previous hysterectomies (group 2). Twelve of the patients received chemotherapy and external irradiation. The remaining four underwent only chemotherapy. The overall survival and freedom from disease progression were analyzed according to Kaplan-Meier methods. Prognoses were related to the International Index, Ann Arbor stage, and International Federation of Gynecology and Obstetrics stage.
Five-year survival and freedom from disease progression were 77% and 67%, respectively, for group 1, and all patients in group 2 were cured. A statistically significant correlation of survival with scores of the International Index was found in group 1. For patients with scores in the low or low-intermediate range (n = 10), 5-year survival was 90%. All patients who scored in the high-intermediate or high range (n = 3) died by 66 months after their diagnosis (P = 0.0153). The Ann Arbor stage had less predictive value, with 5-year survival of 89% for Stage I and II patients (n = 9), compared with 50% survival for the four Stage III and IV patients (P = 0.0701). International Federation of Gynecology and Obstetrics staging did not predict outcome.
The combination of chemotherapy and irradiation is the most effective treatment regimen for all uterine and cervical lymphomas. The International Index is most predictive of outcome.
子宫或宫颈原发性淋巴瘤非常罕见，以至于单个机构的治疗系列病例数量极少，难以确定标准治疗方案。除了疾病最晚期的患者外，对接受化疗和放疗联合治疗的患者的预后进行了分析。
1976年至1992年，16例患者接受了确定性治疗。13例患者子宫完整（第1组），3例在先前子宫切除术后出现阴道旁淋巴瘤（第2组）。12例患者接受了化疗和外照射。其余4例仅接受了化疗。采用Kaplan-Meier方法分析总生存率和无疾病进展生存率。预后与国际预后指数、Ann Arbor分期和国际妇产科联合会分期相关。
第1组的5年生存率和无疾病进展生存率分别为77%和67%，第2组所有患者均治愈。第1组中，生存与国际预后指数评分存在统计学显著相关性。对于低或低-中度评分的患者（n = 10），5年生存率为90%。所有高-中度或高评分的患者（n = 3）在诊断后66个月内死亡（P = 0.0153）。Ann Arbor分期的预测价值较小，I期和II期患者（n = 9）的5年生存率为89%，而4例III期和IV期患者的生存率为50%（P = 0.0701）。国际妇产科联合会分期不能预测预后。
化疗和放疗联合是所有子宫和宫颈淋巴瘤最有效的治疗方案。国际预后指数对预后的预测性最强。
