[Clinicopathological characteristics and prognosis of non-Hodgkin lymphoma in oral and maxillofacial regions: An analysis of 369 cases].

抄録

OBJECTIVE: To investigate the clinicopathological characteristics and factors influencing the prognosis of non-Hodgkin lymphoma (NHL) in oral and maxillofacial regions.

METHODS: Clinicopathological data of 369 patients with oral and maxillofacial NHL initially diagnosed in Peking University Hospital of Stomatology from 2008 to 2020 were collected and analyzed retrospectively.

RESULTS: There were 180 males and 189 females. The median age of the patients was 56 years (3 months to 92 years), and the median duration was three months. Clinically, 283 cases manifested as mass, 38 cases as ulcerative necrotizing lesions, and 48 cases as diffuse soft tissue swelling. The lesions of 90 cases located in face and neck (75 cases neck, 20.3%), 99 cases were of major salivary glands (79 cases parotid glands, 20.9%), 103 cases of oral cavity, 50 cases of maxillofacial bones, 20 cases of Waldeyer's ring, and 7 cases of infratemporal fossa. In the study, 247 of the 369 patients had cervical lymphadenopathy, only 40 cases had B symptoms, and 23 cases had the bulky disease. Of the 369 NHLs, 299 (81%) were B-cell NHL, and 70(19%) were T-cell NHL. Diffuse large B-cell lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, follicular lymphoma, and extranodal natural killer (NK)/T-cell lymphoma nasal type were the most common pathological subtypes. According to Ann Arbor staging, 87, 138, 106, and 38 cases were classified as staged Ⅰ, Ⅱ, Ⅲ, Ⅳ, respectively. The me-dian follow-up time was 48 months, 164 patients died during the follow-up period. The overall survival rates for one year, two years, and five years were 90.1%, 82.4%, and 59.9%, respectively, and the median survival was (86.00±7.98) months. Multivariate analysis showed that age ( < 0.001), Ann Arbor staging ( < 0.001), elevated lactate dehydrogenase (=0.014), and pathological subtype (=0.049) were the independent factors influencing the overall survival rate of NHL patients.

CONCLUSION: Oral and maxillofacial NHL has unique clinical characteristics and distribution patterns of pathological subtypes. Fewer patients had systemic symptoms. Neck and parotid glands were the most common sites invaded by NHL. Advanced age, Ann Arbor stage Ⅲ-Ⅳ, B symptoms, and T-cell NHL may predict a poor prognosis in oral and maxillofacial NHL patients.

目的: 探讨口腔颌面部非霍奇金淋巴瘤(non-Hodgkin lymphoma，NHL)的临床病理特点及影响患者预后的因素。

方法: 回顾性分析2008年1月至2020年6月北京大学口腔医院口腔颌面外科收治的口腔颌面部NHL患者的临床病理资料，结合随访结果，总结其临床病理特点及影响患者预后的因素。

结果: 369例患者中，男性180例，女性189例；中位年龄56岁(3个月至92岁)，中位病期3个月。283例患者临床表现为肿块，38例为组织溃疡坏死，48例呈软组织弥漫性肿胀。病变位于面颈部软组织者90例(颈部75例，占20.3%)，大唾液腺99例(腮腺77例，占20.9%)，口腔软组织103例，颌面部骨组织50例，咽部软组织20例，颞下窝7例。247例伴发颈部淋巴结肿大，仅40例伴有B症状。298例为B细胞NHL，70例为T细胞NHL。弥漫性大B细胞淋巴瘤、黏膜相关淋巴组织淋巴瘤、滤泡淋巴瘤、结外自然杀伤/T细胞淋巴瘤鼻型最常见。Ann ArborⅠ期87例、Ⅱ期138例、Ⅲ期106例、Ⅳ期38例。中位随访时间48个月，164例患者死亡，1年、2年和5年总生存率分别为90.1%、82.4%和59.9%，中位生存期为(86.00±7.98)个月。多因素分析结果显示，年龄( < 0.001)、临床分期( < 0.001)、血清乳酸脱氢酶升高(=0.014)、病理分型(=0.049)是总生存期的独立影响因素。

结论: 口腔颌面部NHL具有多样化的临床表现及独特的病理类型分布，与全身性淋巴瘤存在差异。颈部软组织和腮腺为最常见的受侵部位，患者较少伴全身症状。高龄、临床晚期、伴有B症状、T细胞NHL患者的预后较差。