Maksymiuk A W, Bratvold J S, Ezzat W, Tan L K, Skinnider L F
Department of Medical Oncology, Saskatoon Cancer Centre, Saskatchewan, Canada.
Cancer. 1994 Feb 1;73(3):711-9. doi: 10.1002/1097-0142(19940201)73:3<711::aid-cncr2820730335>3.0.co;2-4.
The incidence and treatment of non-Hodgkin's lymphoma (NHL) have changed in recent years. This study was intended to compare current features with a previous study (1966-1975) and assess the impact of these changes in our jurisdiction.
Clinical features and treatment of 547 patients with NHL registered at our center from January 1980 through December 1989 were reviewed, including reassessment of histologic type in each patient. Multivariate analysis of potential pretreatment prognostic factors was performed using the Cox proportional hazards model, and survival was analyzed in relation to treatment outcome.
This review includes virtually all incident cases of NHL in a defined geographic area, representing an average annual incidence of 11.3/100,000 population. The male-to-female ratio was 1.1:1, median age was 65 years (range, 4-92 years). Median survival time (MST) of 482 patients with disease diagnosed antemortem was 4.8 years (95% confidence interval [CI], 3.7-6.1 years), 52% of whom have died. Thirty-nine percent of patients with disease classified by the International Working Formulation (IWF) had low-grade disease (MST, 103 months); 27% had intermediate disease (MST, 62 months), and 30% had high-grade disease (MST, 35 months). Sixteen percent of patients had associated neoplasms: 4 acute leukemias, 35 skin cancers, and 37 miscellaneous solid tumors. Results of radiation therapy (RT), chemotherapy (CT), and combined CT/RT were analyzed. Survival correlated strongly with responsiveness to treatment. Considering all patients treated with CT, anthracycline-containing CT was associated with the highest response rate, and survival time (more than 48 months) may have been affected by the addition of this agent. A survival advantage for patients with bulky Stage I and II disease treated with consolidative RT after CT is suggested, but not for more advanced stage disease. The proportional hazards model identified histologic type, disease stage, patient age, hemoglobin level, lactate dehydrogenase (LDH) level, bulky abdominal disease, and systemic "B" symptoms as significant independent prognostic factors influencing survival.
The incidence of NHL has increased, and the survival of patients with high-grade disease has improved significantly since the previous study. A high incidence of other associated malignancies was demonstrated in this group of patients with NHL. Recognition of prognostic factors should permit a rational application of innovative treatments for patients in unfavorable prognostic categories.
近年来，非霍奇金淋巴瘤（NHL）的发病率及治疗方法发生了变化。本研究旨在将当前特征与此前一项研究（1966 - 1975年）进行比较，并评估这些变化对我们辖区的影响。
回顾了1980年1月至1989年12月在本中心登记的547例NHL患者的临床特征及治疗情况，包括对每位患者组织学类型的重新评估。使用Cox比例风险模型对潜在的治疗前预后因素进行多变量分析，并根据治疗结果分析生存率。
本综述纳入了一个特定地理区域内几乎所有的NHL发病病例，平均年发病率为11.3/10万人口。男女比例为1.1:1，中位年龄为65岁（范围4 - 92岁）。482例生前确诊疾病的患者中位生存时间（MST）为4.8年（95%置信区间[CI]，3.7 - 6.1年），其中52%已经死亡。根据国际工作分类法（IWF）分类的患者中，39%为低度恶性疾病（MST，103个月）；27%为中度恶性疾病（MST，62个月），30%为高度恶性疾病（MST，35个月）。16%的患者伴有其他肿瘤：4例急性白血病、35例皮肤癌和37例其他实体瘤。分析了放射治疗（RT）、化学治疗（CT）及联合CT/RT的结果。生存率与对治疗的反应密切相关。考虑所有接受CT治疗的患者，含蒽环类药物的CT反应率最高，加入该药物可能影响了生存时间（超过48个月）。提示CT后行巩固性RT对I期和II期有大包块病变的患者有生存优势，但对更晚期疾病则不然。比例风险模型确定组织学类型、疾病分期、患者年龄、血红蛋白水平、乳酸脱氢酶（LDH）水平、腹部大包块病变及全身“B”症状是影响生存的重要独立预后因素。
自此前研究以来，NHL发病率有所上升，高度恶性疾病患者的生存率显著提高。在这组NHL患者中发现其他相关恶性肿瘤的发病率较高。认识预后因素应有助于对预后不良的患者合理应用创新治疗方法。
