透過您的圖書館登入
IP:3.94.77.30
  • 期刊

鼻部NKT細胞淋巴瘤的治療及預後

The Treatment and Prognosis of Nasal NK/T-Cell Lymphoma

摘要


背景:頭頸部淋巴癌中,鼻部自然殺手/T細胞淋巴瘤(natural killer/T-cell lymphoma,NTL)並非罕見,但有其臨床重要性。本研究目的是要對於它的症狀、治療方式及預後提出分析探討。 方法:以回顧病歷及病理切片的方式,共收集26名鼻部NTL之病患,其中男性18名,女性8名,平均年齡53.9歲。發生部位以位於單側下鼻甲、鼻竇以及鼻中隔者(50%)最多,次為廣泛侵犯兩側鼻部(38.5%)),位於鼻咽部者(l1.5%)則最少見。臨床症狀之發生頻率依次為鼻塞佔88.5%、鼻部結痂佔73.1%、膿性鼻漏佔69.2%等。有23.1%病人接受第一次切片後未能確定診斷。本研究針對其性別、年齡、症狀、腫瘤侵犯範圍、治療方式以及預後等加以分析探討。 結果:所有病人的3年整體存活率為33%,依腫瘤分期分析其3年整體存活率,第一期為44%,第二期為25%,第三期為0%,第四期為33%。依腫瘤大小及位置來分析3年整體存活率,局限於單側鼻部或鼻竇者為45%,位於鼻咽部者為50%,廣泛侵犯兩側鼻部或侵犯到口咽部者為13%。分析治療方式對預後之影響,早期病人(第一期及第二期)之3年整體存活率於僅接受放射治療者為33%,接受化療加放射治療者為50%,而晚期病人(第三期及第四期)之3年整體存活率於接受化療加放射治療者與僅接受化療者均為33%。 結論:鼻部NTL病理切片檢查診斷上常不易獲得正確診斷,吾人應特別注意。預後與腫瘤侵犯的大小及位置較有關,對於腫瘤同時侵犯兩側鼻腔的病例應採更積極的治療方式。早期且局限侵犯的病患,建議施予單獨放射治療。而對於早期但廣泛侵犯的病患及晚期病患則建議均施予合併化療及放射治療。

並列摘要


BACKGROUND: Nasal NK/T cell lymphoma is not an uncommon malignancy in the head and neck area. A treatment guideline is yet not well established and it is important to understand its clinical course, treatment modality, and outcome of this disease. This study aims to further understand the clinical symptoms, treatment modality, and prognosis of nasal NK/T cell lymphoma. METHODS: In this study, we have reviewed the charts and pathology slides of patients who were diagnosed with nasal NK/T cell lymphoma in our hospital from Jan. 1995 to Mar. 2002. Twenty-six patients, consisting of l8males and 8 females, were enrolled in this study. The mean age was 53.9 years old and ranged from 20 to 84 years. The location of the tumor was most commonly in the nasal septum, unilateral turbinate, and unilateral paranasal sinus. The clinical symptoms were, in descending rate of occurrence: nasal obstruction, nasal crusting, purulent rhinorrhea, bloody nasal discharge, foul odor, blood-tinged sputum, headache, cervical lymphadenopathy, painful sensation in the nose, and nasal deformity. Nearly one-fourth of these patients did not obtain a definite diagnosis at their first biopsy but were diagnosed at a later biopsy. We discuss the clinical characteristics such as gender, age, symptoms, extent of tumor involvement, treatment modality, and prognosis of the nasal NK/T cell lymphoma. RESULTS: The 3-year overall survival rate was 33%. This was made up of 44% for stage Ⅰ, 25% for stage Ⅱ, 0% for stage Ⅲ, and 33% for stage Ⅳ In terms of the various tumor locations, the 3-year overall survival rate was 45% for tumors localized in the nasal cavity and/or the unilateral paranasal sinus, 50% for tumors localized in the nasopharynx, and 13% for tumors extensively involving the bilateral nasal cavity and/or oropharynx. In early-staged patients (stage Ⅰ and Ⅱ), the 3-year survival rate of patients who received radiation therapy alone was 33%. This increased to 50 % for patients who received chemotherapy plus radiation therapy. In late-staged patients (stage Ⅲ and Ⅳ), the 3-year survival rate was 33% for both patients who received chemotherapy plus radiation therapy and for those who received chemotherapy alone. CONCLUSION: Nasal NK/T cell lymphoma is not a rare head and neck malignancy. In clinical practice, it is not always easy to obtain a correct diagnosis even after biopsy and we should be more aware of this disease in order to improve early detection. The prognosis is closely related to the location and extension of the tumor. We recommend performing radiation therapy alone in early-staged and tumor-localized patients, and performing radiation therapy plus chemotherapy for early-staged but extensive tumors. For late-staged patients, we recommend performing both chemotherapy and radiation therapy.

延伸閱讀