Ezzat A A, Ibrahim E M, El Weshi A N, Khafaga Y M, AlJurf M, Martin J M, Ajarim D S, Bazarbashi S N, Stuart R K, Zucca E
Department of Oncology, King Faisal Specialist Hospital & Research Centre, PO Box 3354, Riyadh, 11211, Saudi Arabia.
Head Neck. 2001 Jul;23(7):547-58. doi: 10.1002/hed.1077.
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.
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 between 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 CMT was not associated with a superior OS compared with either of the single modality treatments; however, it was associated with more favorable EFS.
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.
在所有淋巴瘤患者中，约5%至10%的患者非霍奇金淋巴瘤（NHL）累及韦氏环（WR），且其占头颈部所有原发性结外淋巴瘤的一半以上。材料与方法 对一家机构18年间收治的130例局限性（I期和II期）WR - NHL成年患者进行回顾性分析。
患者中位年龄55岁，男女比例为1.5:1。分别有75例（58%）、46例（35%）和9例（7%）患者患有原发性扁桃体、鼻咽和舌根淋巴瘤。45例（35%）为I期疾病，85例（65%）为II期疾病。大多数患者（109例，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%）接受了放射治疗（RTX），46例（35%）采用化疗和放疗联合治疗（CMT）。109例（84%）、16例（12%）和5例（4%）患者分别达到完全缓解（CR）、部分缓解（PR）和治疗失败，三种治疗方式的CR率无差异。在患有DLC的患者中，分别有90例（83%）、15例（14%）和4例（3%）表现为CR、PR和治疗失败。多因素分析发现，改良国际预后指数（IPI）可预测CR的达成情况。中位随访49个月；76例（58%）患者存活且无疾病，5例（4%）患者存活但有疾病证据，其余49例（38%）死亡。最常见的远处复发部位是非胃肠道结外部位。中位总生存期（OS）尚未达到；然而，预计5年OS为58%。I期和II期患者的OS无差异。Cox比例风险模型确定原发性扁桃体部位以及改良IPI定义的低风险组与良好的OS相关。中位无事件生存期为82.3个月，在多因素分析中，原发性扁桃体部位和低风险改良IPI组与良好的无事件生存期相关。可能由于DLC患者比例较高，这些患者的结局和预后因素与整个组并无差异。与单一治疗方式相比，CMT并未带来更好的OS；然而，它与更有利的无事件生存期相关。
本系列研究描述了成年早期WR - NHL患者的临床病理特征和结局。I期和II期患者的生存无差异，且结局良好。原发性扁桃体部位和改良IPI的低风险组预测了良好的OS和无事件生存期。CMT可能优于单一治疗方式；然而，仍需进行前瞻性研究。
