Localized non-Hodgkin's lymphoma of Waldeyer's ring: Clinical features, management, and prognosis of 130 adult patients
Localized non-Hodgkin's lymphoma of Waldeyer's ring: Clinical features, management, and prognosis of 130 adult patients
复制标题
DOI：
10.1002/hed.1077
复制
发表时间：
2001-07-01
影响因子：
2.9
通讯作者：
Zucca, E
中科院分区：
文献类型：
--
作者：
Ezzat, AA;Ibrahim, EM;Zucca, E
背景Waldeyer环（WR）是所有淋巴瘤患者中约5%至10%的非霍奇金淋巴瘤（NHL）累及的主要部位，并且其占头颈部所有原发性淋巴结淋巴瘤的一半以上。对130例成人局限性（I期和II期）WR-NHL患者进行回顾性分析。患者的中位年龄为55岁，男女比例为1：5：1。原发性扁桃体、鼻咽和舌根淋巴瘤分别为75例（58%）、46例（35%）和9例（7%）。分别有45例（35%）和85例（65%）患有I期和II期疾病。大多数患者（109例患者，84%）患有弥漫性大B细胞NHL（DLC）。58例（45%）患者接受了化疗（CT），26例（20%）患者接受了放疗（RTX），46例（35%）患者接受了化疗和放疗（CMT）联合治疗。分别有109例（84%）、16例（12%）和5例（4%）患者达到完全缓解（CR）、部分缓解（PR）和治疗失败，三种治疗方式的CR率无差异。在这些DLC患者中，分别有90例（83%）、15例（14%）和4例（3%）显示CR、PR和治疗失败。在多变量分析中，改良国际预后指数（IPI）被发现预测CR的实现。中位随访时间为49个月; 76例（58%）患者存活且无疾病，5例（4%）存活且有疾病证据，其余49例（38%）死亡。大多数远端复发发生在非胃肠结直肠部位。尚未达到中位总生存期（OS）;然而，预计5年OS为58%。I期和II期患者的OS无差异。考克斯比例风险模型确定原发扁桃体部位和改良IPI定义的低风险组与良好的OS相关。多因素分析中，原发扁桃体部位和改良IPI定义的低风险组与良好的EFS相关，中位无事件生存期为82.3个月。可能是因为DLC患者的高频率，这些患者的结局和预后因素与整个组的结局和预后因素没有区别。GMT与任何一种单一方式治疗相比，与上级OS无关;然而，它与更有利的EFS相关。该系列研究描述了早期WR-NHL成人患者的临床病理特征和结局。在I期和II期之间没有观察到生存差异，结局是有利的。原发扁桃体部位和改良IPI的低风险组预测OS和EFS有利。CMT可能上级单一模式治疗;然而，前瞻性研究是必要的。(C)2001年John Wiley & Sons。Inc.头颈23：547-558。2001.
Background. Waldeyer's ring (WR) is the primary site of non-Hodgkin's lymphoma (NHL) involvement in approximately 5% to 10% of all lymphoma patients, and it accounts for more than half of all primary extranodal lymphomas of the head and neck.Materials and Methods. A retrospective review was performed of 130 adult patients with localized (stages I and II) WR-NHL seen at a single institution over 18 years.Results. Patients had a median age of 55 years, and the male-female ratio was 1:5:1. Seventy five (58%), 46 (35%), and 9 (7%) patients had primary tonsillar, nasopharyngeal, and base of the tongue lymphoma, respectively. Forty-five (35%) and 85 (65%) had stage I and stage II disease, respectively. Most patients (109 patients, 84%) had diffuse large B-cell NHL (DLC). Chemotherapy (CT) was given to 58 (45%) patients, whereas 26 (20%) received radiation therapy (RTX), and 46 (35%) were managed with a combination of chemotherapy and radiotherapy (CMT). One hundred nine (84%), 16 (12%), and 5 (4%) patients attained complete remission (CR), partial remission (PR), and treatment failure, respectively, with no difference in CR rates be tween the three therapeutic modalities. Of those patients with DLC, 90 (83%), 15 (14%), and 4 (3%) demonstrated CR, PR, and treatment failure, respectively. In a multivariate analysis, the modified international Prognostic Index (IPI) was found to predict the attainment of CR. Over a median follow-up of 49 months; 76 (58%) of the patients were alive and disease-free, 5 (4%) were alive with evidence of disease, and the remaining 49 (38%) were dead. Most distant relapses were in nongastrointestinal extranodal sites. The median overall survival (OS) has not been reached; however, the projected 5-year OS was 58%. No OS difference was noted between patients with stage I and stage II. Cox proportional hazards model identified primary tonsillar site and a low-risk group as defined by the modified IPI were associated with favorable OS. The median event-free survival was 82.3 months, with the primary tonsillar site, and low-risk modified IPI group were associated with favorable EFS in a multivariate analysis. Probably because of the high frequency of patients with DLC, the outcome and the prognostic factors in those patients were not distinctive from those for the whole group. The GMT was not associated with a superior OS compared with either of the single modality treatments; however, it was associated with more favorable EFS.Conclusions. This series characterized the clinicopathologic features and outcome of adult patients with early stage WR-NHLs. No survival difference was noted between stage I and stage II, and the outcome was favorable. Primary tonsillar site and the low-risk group of the modified IPI predicted favorable OS and EFS. CMT is probably superior to single modality treatment; however, prospective studies are warranted. (C) 2001 John Wiley & Sons. Inc. Head Neck 23: 547-558. 2001.