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北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (1): 35-42. doi: 10.19723/j.issn.1671-167X.2019.01.007

• 论著 • 上一篇    下一篇

原发性腮腺淋巴瘤的临床病理特点及预后分析

宿骞1,彭歆1,周传香2,△(),俞光岩1,△()   

  1. 1. 北京大学口腔医学院·口腔医院,口腔颌面外科,北京　100081
    2. 北京大学口腔医学院·口腔医院, 病理科　国家口腔疾病临床医学研究中心　口腔数字化医疗技术和材料国家工程实验室　口腔数字医学北京市重点实验室,北京　100081
  • 收稿日期:2018-10-15 出版日期:2019-02-18 发布日期:2019-02-26
  • 通讯作者: 周传香,俞光岩 E-mail:zhoucx2008@126.com;gyyu@263.net

Clinicopathological features and possible prognostic factors in parotid lymphomas

Qian SU1,Xin PENG1,Chuan-xiang ZHOU2,△(),Guang-yan YU1,△()   

  1. 1. Department of Oral and Maxillofacial Surgery, Beijing 100081, China
    2. Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2018-10-15 Online:2019-02-18 Published:2019-02-26
  • Contact: Chuan-xiang ZHOU,Guang-yan YU E-mail:zhoucx2008@126.com;gyyu@263.net

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摘要：

目的: 探讨原发性腮腺淋巴瘤的临床病理特点及影响其预后的因素。方法: 收集2006—2016年于北京大学口腔医院口腔颌面外科就诊并诊断为原发性腮腺淋巴瘤患者的相关临床资料,结合复查随访资料,回顾性总结其临床病理特点及患者预后,分析影响预后的相关因素。结果:研究共纳入41例患者,中位年龄57岁(8个月至91岁),男 ∶女=1 ∶2.15,女性多见。40例(97.1%)为非霍奇金淋巴瘤(non-Hodgkin lymphoma,NHL),其中结外边缘区黏膜相关淋巴组织淋巴瘤(extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue,MALT)15例,弥漫性大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)14例,滤泡型淋巴瘤(follicular lymphoma,FL)4例,其他类型少见,霍奇金淋巴瘤(Hodgkin lymphoma,HL)仅占1例。Ann Arbor ⅠE~ⅡE期37例(90.2%),ⅢE~ⅣE期4例(9.8%)。7例(17.1%)淋巴瘤由干燥综合征恶变而来,均为MALT淋巴瘤。平均病期为20.7月,78%的患者以腮腺区缓慢生长的无痛性肿块为主要症状。治疗方法包括局部治疗及系统治疗,不同治疗方案均可取得较好疗效。全部患者均经5~149个月随访,其中9例(21.9%)死亡,2年总生存率为84.5%,5年总生存率为81.3%。单因素分析显示有无肿物加速生长史(P=0.005)和肿物有无包膜(P=0.011)为总生存率的影响因素,多因素分析显示肿物有无包膜(P=0.041)影响患者的总生存期。结论:腮腺淋巴瘤绝大多数为B细胞型NHL,MALT淋巴瘤与DLBCL最为常见,大部分患者表现为缓慢生长的腮腺区局限性肿块,临床上需与腮腺良性肿瘤相鉴别。干燥综合征与MALT淋巴瘤的发病密切相关。原发性腮腺淋巴瘤患者预后比其他恶性肿瘤相对较好,肿物无包膜提示预后较差。

关键词: 淋巴瘤, 腮腺, 临床病理, 预后

Abstract:

Objective: To investigate the clinicopathological features and prognostic factors in lymphoma of parotid origin. Methods: Clinicopathological data of the patients with parotid lymphoma who were initially diagnosed in Peking University Hospital of Stomatology from 2006 to 2016 were collected and analyzed retrospectively. The patients were followed-up for 5 to 149 months with a median period of 45 months, and the factors influencing the prognosis were evaluated. Results: A total of 41 patients with primary parotid lymphoma were included in this retrospective study. The rate of male to female was 1 ∶2.15. The median age was 57 years (ranging from 8 months to 91 years). According to WHO classification, 40 cases (97.1%) were diagnosed as non-Hodgkin lymphoma (NHL), including 15 cases of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT), 14 cases of diffuse large B cell lymphoma (DLBCL) as well as 4 cases of follicular lymphoma, while other subtypes of NHL were rare. Only one case was diagnosed as Hodgkin lymphoma. Regarding the clinical staging at the initial diagnosis, 37 patients (90.2%) were diagnosed as stage ⅠE or ⅡE of the disease, while 4 patients (9.8%) as stage ⅢE or stage ⅣE. Seven patients (17.1%) had a history of Sjögren syndrome (SS), all of whom were MALT lymphoma. The mean ill duration of the 41 patients were 20.7 months. Thirty-two patients (78%) presented a slowly growing painless mass in the parotid gland. Treatment options included localized therapy and systemic therapy, all of whom had good curative effect. Nine patients (21.9%) died during the follow-up period. The overall survival rates of 2-year and 5-year were 84.5% and 81.3% respectively. The univariate analysis demonstrated statistically significant differences for accelerated growth of tumor (P=0.005), and presence of tumor capsule (P=0.011). The multi-univariate analysis demonstrated statistically significant differences for presence of tumor capsule (P=0.041). Conclusion: A large majority of primary parotid lymphoma were NHL, among which MALT lymphoma and DLBCL were common subtypes. Most patients presented an indolent mass in parotid gland, which should be distinguished from the parotid benign tumors. SS is closely related to the pathogenesis of MALT lymphoma. The prognosis is better than that of other malignant parotid tumors. Absence of tumor capsule may predict a poor prognosis in patients with parotid lymphoma.

Key words: Lymphoma, Parotid gland, Clinical pathology, Prognosis

中图分类号: 

  • R733.41

表1

41例腮腺淋巴瘤患者的临床特点"

Clinical features n (%)
Gender
Female 28 (68.3)
Male 13 (31.7)
Age
≥60 years 23 (56.1)
<60 years 18 (43.9)
Accelerated growth of tumor 11 (26.8)
Tumors without capsule 15 (36.6)
Extent
Unilateral 36 (87.8)
Bilateral 5 (12.2)
Location
Superficial lobe 38 (92.7)
Deep lobe 3 (7.3)
Histologic classification
MALT 15 (36.6)
DLBCL 14 (34.1)
FL 4 (9.7)
LL 2 (4.9)
LBL 2 (4.9)
Other NHL 3 (7.3)
HL 1 (2.4)
Ann Arbor stage
Stage Ⅰ and Ⅱ 37 (90.2)
Stage Ⅲ and Ⅳ 4 (9.8)
Autoimmune disorders 8 (19.5)
Sjögren syndrome 7 (17.1)
Rheumatoid arthritis 1 (2.4)
Cervical lymph node enlargement 12 (34.3)
Local symptoms 9 (22.0)
Spontaneous pain 9 (22.0)
Facial paralysis 2 (4.8)
Special infection 4 (9.8)
HCV 1 (2.4)
HBV 3 (7.3)
HIV 0
Elevated LDH level 1 (2.4)
B symptoms 0

图1

腮腺黏膜相关淋巴组织淋巴瘤"

图2

腮腺滤泡淋巴瘤"

图3

41例腮腺淋巴瘤的治疗情况统计"

图4

41例腮腺淋巴瘤生存曲线"

表2

原发性腮腺淋巴瘤影响生存率的单因素分析"

Risk factor 2-year
OS/%		 5-year
OS/%		 Log-rank
χ2		 P according to
Log-rank		 HR (95%CI) P according to Cox
Gender 0.014 0.907 0.960 (0.479-1.922) 0.907
Female 84.6 84.6
Male 84.5 79.5
Age 4.128 0.042 0.475 (0.216-1.043) 0.063
≥60 years 76.2 69.8
<60 years 90.9 90.9
Accelerated growth of tumor 7.846 0.005 5.446 (1.446-20.516) 0.012
Yes 47.7 47.7
No 96.0 90.9
Location 1.825 0.177 4.005 (0.455-35.283) 0.211
Superficial lobe 86.3 83.0
Deep lobe 50.0 50.0
Local symptoms 2.414 0.120 3.004 (0.701-12.876) 0.138
Yes 57.1 57.1
No 90.2 86.1
Histologic classification 0.843 0.359 0.697 (0.317-1.532) 0.369
MALT 92.3 83.1
Other subtypes 80.0 80.0
Ann Arbor stage 2.480 0.115 0.545 (0.224-1.216) 0.138
Stage Ⅰ and Ⅱ 85.9 82.3
Stage Ⅲ and Ⅳ 66.7 66.7
Sjögren syndrome 0.383 0.536 0.5203 (0.065-4.224) 0.543
Yes 81.5 81.5
No 100 83.3
Surgery 0.270 0.603 0.660 (0.136-3.206) 0.606
Yes 87.0 83.1
No 75.0 75.0
Tumor capsule 6.410 0.011 0.131 (0.026-0.653) 0.013
Yes 95.2 63.0
No 77.9 64.9

表3

腮腺淋巴瘤影响生存率因素的多因素分析"

Risk factor HR (95%CI) P
Accelerated growth of tumor (Yes/No) 3.715
(0.943-14.632)		 0.061
Tumor capsule (Yes/No) 0.178
(0.034-0.932)		 0.041

图5

肿物是否存在包膜的多因素生存分析"

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