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目的探讨原发于纵隔大Ｂ细胞恶性淋巴瘤的临床特性和治疗方法。材料与方法１９８０年至１９９２年，收治３６例原发于纵隔大Ｂ细胞恶性淋巴瘤。所有病理材料经复核和免疫组化检测。接受局部野照射１５例，大面积不规则野照射２１例。照射剂量＞４５Ｇｙ２３例，≤４５Ｇｙ１３例。２９例合并化疗。结果随访６３～２１３月。５年生存率６１．１％；５年无瘤生存率５８．３％；１０年生存率５８．４％；１０年无瘤生存率５５．５％。获得完全缓解（ＣＲ）者生存率明显高于部分缓解（ＰＲ）和进展（ＰＤ），Ｐ＜０．００１。肿瘤侵犯邻近器官者，其预后明显差于未侵犯邻近器官者，无Ｂ症状者预后优于有Ｂ症状者，但统计学分析差异无显著性。经Ｃｏｘ模型多因素分析，性别、年龄、肿块大小３因素对预后均无明显的影响。Ｌｏｇ－ｒａｎｋ检验局部野照射与大面积野照射，放射总剂量＞４５Ｇｙ与总量≤４５Ｇｙ之间的疗效，差异均无显著性意义。放化疗结合组的疗效明显优于单纯放疗组，Ｐ＝０．００４２。结论原发于纵隔大Ｂ细胞恶性淋巴瘤有独特的临床和病理特点。治疗以化疗为主。结合局部放射治疗，总剂量以４５Ｇｙ左右为宜。治疗结束后残留的病人应考虑调整化疗方案和（或）局部追加剂量，争取最大限度的?
Objective To investigate the clinical features and treatment of primary large malignant lymphoma in mediastinal large B cell. Materials and Methods From 1980 to 1992, 36 patients with malignant primary lymphoma of the mediastinum were treated. All pathological materials were reviewed and immunohistochemically tested. Received partial field irradiation in 15 cases, large area irregular field irradiation in 21 cases. Irradiation dose> 45Gy23 cases, ≤45Gy13 cases. 29 cases with chemotherapy. The results were followed up from 63 to 213 months. 5-year survival rate of 61.1%; 5-year disease-free survival rate of 58.3%; 10-year survival rate of 58.4%; 10-year disease-free survival rate of 55.5%. Patients who achieved complete remission (CR) had significantly higher survival rates than those with partial response (PR) and progression (PD), P <0.001. Tumor invasion of neighboring organs, the prognosis was significantly worse than those who did not violate the adjacent organs, no B symptoms outweig better than those with B symptoms, but the statistical analysis showed no significant difference. Cox model by multivariate analysis, sex, age, size of the tumor had no significant effect on prognosis. Log-rank test showed that there was no significant difference in the curative effect between the total field radiation and the large area field radiation, the total radiation dose> 45 Gy and the total dose less than 45 Gy. Radiotherapy and chemotherapy combination group was significantly better than the radiotherapy alone group, P = 0.0042. Conclusion The primary malignant primary mediastinal large B cell lymphoma has a unique clinical and pathological features. Chemotherapy-based treatment. Combined with local radiotherapy, the total dose of about 45Gy appropriate. Residual patients after treatment should consider adjusting the chemotherapy regimen and / or local additional dose, to maximize?