NON-HODGKINS-LYMPHOMA OF THE THYROID - IS MORE THAN BIOPSY NECESSARY
NON-HODGKINS-LYMPHOMA OF THE THYROID - IS MORE THAN BIOPSY NECESSARY
复制标题
DOI：
10.1007/bf02067333
复制
发表时间：
1992-07-01
影响因子：
2.6
通讯作者：
HAY, ID
中科院分区：
文献类型：
--
作者：
PYKE, CM;GRANT, CS;HAY, ID
虽然当非霍奇金甲状腺淋巴瘤（NHLT）局限于甲状腺时，手术切除和放射治疗的结果是有利的，但当疾病不能完全切除时，积极减积术与单独诊断活检的潜在优势仍存在争议。我们在这项研究中的目的是描述手术在NHLT术前分期中的作用，切除程度对实现完全缓解和病因特异性生存的影响，以及失败的模式。我们分析了1965年至1989年间在梅奥诊所接受过初级手术的62名患者。术后分期50例为IE期或IIE期。5年和10年的总生存率分别为53%和46%；局限于甲状腺的IE期占80%，IE-甲状腺外期占58%，IIE期占50%，IIE和IVE期占36%。单独接受诊断性活检加辅助治疗的患者中，88%的患者达到完全缓解，而使用减体积加辅助治疗的患者中，这一比例为85%。这两组的病因特异性生存率没有差异，达到完全缓解的两个亚组的病因特异性生存率没有差异。46例患者中有12例（26%）在完全缓解后复发，其中只有2例在补救性治疗后长期存活。手术在NHLT中的作用正在减弱，提高完全缓解和无复发生存率的进展不太可能涉及更积极的手术切除。
Whereas excisional surgery and radiotherapy have resulted in a favorable outcome when non-Hodgkin's lymphoma of the thyroid (NHLT) is confined to the thyroid gland, controversy persists over the potential advantage of aggressive debulking in favor of diagnostic biopsy alone when disease cannot be completely resected. Our aims in this study were to delineate the present role of surgery in NHLT in pre-operative staging, the impact of the extent of resection on achieving complete remission and cause-specific survival, and patterns of failure. All 62 patients who underwent primary surgery for NHLT at the Mayo Clinic between 1965 and 1989 were analyzed. By postoperative staging, 50 patients were stage IE or IIE. Overall survival was 53% and 46% at 5 and 10 years; 80% for stage IE confined to the thyroid, 58% for stage IE-extrathyroid, 50% for stage IIE, and 36% for stages IIIE and IVE. Complete remission was achieved in 88% of patients who underwent diagnostic biopsy plus adjuvant therapy alone compared to 85% for patients in whom debulking plus adjuvant therapy was used. There was no difference in cause-specific survival in these two groups or in cause-specific survival in two subgroups who achieved complete remission. Relapse after complete remission occurred in 12 (26%) of 46 patients, only 2 of whom survived long-term after salvage therapy. The role of surgery in NHLT is diminishing and advances that will increase complete remission and relapse-free survival will not likely involve more aggressive surgical resections.