Outcome analysis for stage IE and IIE thyroid lymphoma
Outcome analysis for stage IE and IIE thyroid lymphoma
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DOI：
10.1097/01.coc.0000054891.30422.b5
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发表时间：
2004-04-01
影响因子：
2.6
通讯作者：
Wasserman, TH
中科院分区：
文献类型：
--
作者：
DiBiase, SJ;Grigsby, PW;Wasserman, TH
以前的报告显示，在甲状腺淋巴瘤的管理与放疗单独适度的结果。本回顾性报告评价了在一家机构接受单纯放疗和联合治疗（化疗和放疗）的甲状腺淋巴瘤患者的结局。1960年至1998年在Barnes-Jewish医院治疗了27例IE和HE期甲状腺非霍奇金淋巴瘤患者，其中14例为IE期，13例为IIE期。诊断时的中位年龄为67岁，评价了21名女性和6名男性。中位随访时间为38个月（范围：3-279个月）。所有患者均经组织学证实为非霍奇金淋巴瘤，其中22例（81%）为中度。治疗包括19例单纯放疗和8例综合治疗。甲状腺床的中位辐射剂量为44戈伊，大多数患者在放疗前接受了含阿霉素的治疗方案。采用考克斯回归分析评价患者、肿瘤和治疗相关特征。使用Kaplan-Meier方法计算局部-区域肿瘤控制、无病生存期（DFS）和总生存期（OS）。4例患者局部复发，粗略的局部肿瘤控制率为85%。确定没有因子对局部肿瘤控制具有显著性。整个队列的精算5年DFS和OS分别为57%和56%。在DFS方面，年龄和分期均具有统计学意义。年龄小于65岁的患者的5年精算DFS为83%，大于65岁的患者为37%（p = 0.024）。此外，I期和11期疾病患者的5年精算DFS分别为69%和45%（p = 0.022）。在多变量分析中，年龄对于DFS仍然是显著的（p = 0.049）。总生存率分析显示年龄、局部肿瘤控制和分期在单变量分析中具有显著性。使用考克斯比例风险模型进一步进行多变量分析，发现年龄（p = 0.006）和局部肿瘤控制（p = 0.007）具有显著性。原发性甲状腺淋巴瘤有良好的结果与适当的治疗，但预后取决于临床分期和年龄在介绍。由于局部区域和远处失败的风险，使用化疗和放疗的联合方式方法是必要的中，高级别甲状腺淋巴瘤。
Previous reports have revealed modest results in the management of thyroid lymphoma with radiotherapy alone. This retrospective report evaluates the outcome of patients treated for thyroid lymphoma with radiotherapy alone and with combined modality therapy (chemotherapy and radiotherapy) at a single institution. Twenty-seven patients with stages IE and HE non-Hodgkin's lymphoma of the thyroid gland were treated between 1960 and 1998 at Barnes-Jewish Hospital, of which 14 patients were stage IE and 13 patients were stage IIE. The median age at diagnosis was 67 years, and there were 21 females and 6 males evaluated. The median follow-up time was 38 months (range: 3-279 months). All patients had histologically proven non-Hodgkin's lymphoma, of which 22 patients (81%) were intermediate grade. Treatment consisted of radiotherapy alone in 19 patients and a combined modality therapy in 8 patients. The median radiation dose to the thyroid bed was 44 Gy, and most patients received a doxorubicin-containing regimen administered prior to radiotherapy. Patient, tumor, and treatment-related characteristics were evaluated using Cox regression analysis. Local-regional tumor control, disease-free survival (DFS), and overall survival (OS) were calculated using the Kaplan-Meier method. Four patients had local relapse in this series, with a crude local tumor control rate of 85%. No factor was determined to be significant for local tumor control. The actuarial 5-year DFS and OS for the entire cohort were 57%, and 56%, respectively. In terms of DFS, both age and stage were statistically significant. The 5-year actuarial DFS for patients less than age 65 years was 83% versus 37% for those more than this age (p = 0.024). Furthermore, the 5-year actuarial DFS for patients with stage I and 11 disease was 69% and 45%, respectively (p = 0.022). In multivariate analysis, age continued to be significant for DFS (p = 0.049). Overall survival analysis revealed age, local tumor control, and stage to be significant in univariate analysis. Multivariate analysis was further carried out using Cox proportional hazard model, and it revealed age (p = 0.006) and local tumor control (p = 0.007) to be significant. Primary thyroid gland lymphomas have a favorable outcome with appropriate therapy, but prognosis depends on both clinical stage and age at presentation. Because of the risk of both local-regional and distant failure, combined modality approaches that use chemotherapy with radiotherapy are warranted for intermediate- and high grade thyroid lymphoma.