20例原发性甲状腺淋巴瘤的临床分析

摘要

目的：分析原发性甲状腺淋巴瘤的临床表现、诊断、治疗及预后。方法回顾1993年6月-2013年6月解放军总医院收治的原发性甲状腺淋巴瘤20例，分析其临床表现、诊断经过、治疗方案及预后。按疾病分期及是否接受手术分组，分析不同病理类型患者的生存情况。结果1例入院当天因窒息死亡未做治疗，5例通过超声引导穿刺活检明确诊断后接受化疗或化疗+放疗，14例接受单纯手术、手术+化疗或手术+化疗+放疗。中位随访期为41(0~131)个月，随访仍未到达终点。3例黏膜相关淋巴组织淋巴瘤(mucosa-associated lymphoma tissue，MALT)患者长期存活；弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma，DLBCL)ⅠE期2年、5年生存率均为100％(5例)，ⅡE期2年、5年生存率分别为72.9%(6例)和58.3%(5例)，ⅠE期DLBCL患者预后优于ⅡE期患者(P=0.048)。DLBCL中接受手术患者2年、5年生存率均为74.1%(7例)，未接受手术患者(不包括未治疗患者1例)2年、5年生存率分别为100%(4例)和75.0%(3例)。是否接受手术对DLBCL患者预后无显著影响(P=0.804)。结论 MALT患者经过治疗可长期存活，ⅠE期DLBCL患者预后优于ⅡE期。手术对DLBCL患者预后无显著影响，外科手术的干预应慎重选择。%Objective To analyze the clinical presentation, pathological type, diagnosis, treatment and prognosis of primary thyroid lymphoma (PTL).Methods Clinical data about 20 cases with primary thyroid lymphoma admitted to Chinese PLA General Hospital from June 1993 to June 2013, including clinical manifestation, diagnosis procedure, treatment project and prognosis, were reviewed. According to the stage of primary thyroid lymphoma and whether accepted operation, patients with different pathological types were divided into different groups and their overall survival was analyzed.Results One case died of suffocation without treatment, 5 cases underwent chemotherapy or chemotherapy + radiotherapy after ultrasound guided puncture biopsy for diagnosis, 14 cases underwent operation, operation + chemotherapy or operation + chemotherapy + radiotherapy. The median follow-up time of all patients was 41 months (0 - 131 months), but the follow-up had not reached the end yet. Three MALT patients got long-term survival. The 2-year and 5-year survival rates ofⅠE stage DLBCL were 100% (5 cases) and 100% (5 cases) respectively. The 2-year and 5-year survival rates ofⅡE stage DLBCL were 72.9%(6 cases) and 58.3% (5 cases) respectively. The prognosis of DLBCL patients with stageⅠE was better thanⅡE (P=0.048). The 2-year and 5-year survival rates of DLBCL patients underwent surgery were 74.1% (7 cases) and 74.1% (7 cases) respectively. The 2-year and 5-year survival rates of DLBCL patients without surgery were 100% (4 cases) and 75.0% (3 cases), which showed no significant difference between two groups (P=0.804).Conclusion MALT patients with treatment can get a long-term survival. The prognosis of stageⅠE patients with DLBCL is better than that of stageⅡE patients. Operation has no significant effect on the prognosis of patients with DLBCL. Surgical operation intervention should be chosen carefully.