Ha C S, Dubey P, Goyal L K, Hess M, Cabanillas F, Cox J D
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Am J Clin Oncol. 1998 Aug;21(4):376-80. doi: 10.1097/00000421-199808000-00012.
A single institution's experience with the treatment of localized primary lymphoma of the breast (PLB) was analyzed to understand the natural history of this disease and to identify major prognostic factors and optimal treatment. A retrospective analysis of 23 previously untreated patients who met the strict criteria of PLB from 1972 through 1994 was undertaken. All pathologic materials were reviewed and classified by the Working Formulation. The Ann Arbor stages (AASs) were: IE, 17 patients; IIE, five patients; IV, one patients (bilateral breast involvement without distant metastasis). Pathologic findings were: low grade, two patients; intermediate grade, 18 patients (17 with diffuse large-cell lymphoma (DLCL)); high grade, two patients; and unclassifiable, one patient. The treatments after biopsy or mastectomy were: radiation alone, two patients; chemotherapy alone, six patients; and combined-modality therapy, 13 patients. Two patients had mastectomy alone. Overall survival (OS) and relapse-free survival (RFS) were calculated actuarially. Univariate analyses were performed with patient age, treatment modality, AAS, size of the primary tumor (T stage), and International Prognostic Index (IPI) for the 17 patients with DLCL to define prognostic factors. The median follow-up for the surviving patients was 78 months (range, 45-220 months). The 5-year OS and RFS were 74% and 73%, respectively for all 23 patients, and 65% and 70%, respectively, for the 17 patients with DLCL. Statistically significant factors for OS for DLCL were AAS and IPI. Statistically significant factors for RFS were AAS and T stage. With modern staging evaluation and multiagent combination chemotherapy, localized primary non-Hodgkin lymphoma of the breast, especially diffuse large-cell type, has a prognosis as favorable as that of other DLCL. Ann Arbor stage was a significant factor for both OS and RFS.
分析了一家机构治疗局限性原发性乳腺淋巴瘤（PLB）的经验，以了解该疾病的自然史，确定主要预后因素和最佳治疗方法。对1972年至1994年间23例符合PLB严格标准的未经治疗的患者进行了回顾性分析。所有病理材料均根据工作分类法进行审查和分类。Ann Arbor分期（AAS）为：IE期，17例患者；IIE期，5例患者；IV期，1例患者（双侧乳腺受累无远处转移）。病理结果为：低级别，2例患者；中级，18例患者（17例为弥漫性大细胞淋巴瘤（DLCL））；高级别，2例患者；无法分类，1例患者。活检或乳房切除术后的治疗方法为：单纯放疗，2例患者；单纯化疗，6例患者；综合治疗，13例患者。2例患者仅行乳房切除术。采用精算方法计算总生存期（OS）和无复发生存期（RFS）。对17例DLCL患者，就患者年龄、治疗方式、AAS、原发肿瘤大小（T分期）和国际预后指数（IPI）进行单因素分析，以确定预后因素。存活患者的中位随访时间为78个月（范围45 - 220个月）。所有23例患者的5年OS和RFS分别为74%和73%，17例DLCL患者分别为65%和70%。DLCL患者OS的统计学显著因素为AAS和IPI。RFS的统计学显著因素为AAS和T分期。通过现代分期评估和多药联合化疗，局限性原发性乳腺非霍奇金淋巴瘤，尤其是弥漫性大细胞型，其预后与其他DLCL一样良好。Ann Arbor分期是OS和RFS的重要因素。
