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北京大学学报（医学版） ›› 2023, Vol. 55 ›› Issue (1): 13-21. doi: 10.19723/j.issn.1671-167X.2023.01.003

• 论著 • 上一篇    下一篇

369例口腔颌面部非霍奇金淋巴瘤的临床病理特点及预后

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，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，口腔数字医学北京市重点实验室，国家卫生健康委员会口腔医学计算机应用工程技术研究中心，国家药品监督管理局口腔生物材料重点实验室，北京 100081
    2. 北京大学口腔医学院·口腔医院口腔病理科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，口腔数字医学北京市重点实验室，国家卫生健康委员会口腔医学计算机应用工程技术研究中心，国家药品监督管理局口腔生物材料重点实验室，北京 100081
  • 收稿日期:2022-10-10 出版日期:2023-02-18 发布日期:2023-01-31
  • 通讯作者: 周传香,俞光岩 E-mail:zhoucx2008@126.com;gyyu@263.net
  • 基金资助:
    国家自然科学基金(81974151)

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

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

  1. 1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomato-logy & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
    2. Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomato-logy & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
  • Received:2022-10-10 Online:2023-02-18 Published:2023-01-31
  • Contact: Chuan-xiang ZHOU,Guang-yan YU E-mail:zhoucx2008@126.com;gyyu@263.net
  • Supported by:
    National Natural Science Foundation of China(81974151)

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摘要：

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(P < 0.001)、临床分期(P < 0.001)、血清乳酸脱氢酶升高(P=0.014)、病理分型(P=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。

关键词: 口腔颌面部, 非霍奇金淋巴瘤, 临床病理, 预后

Abstract:

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 (P < 0.001), Ann Arbor staging (P < 0.001), elevated lactate dehydrogenase (P=0.014), and pathological subtype (P=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.

Key words: Oral and maxillofacial regions, Non-Hodgkin lymphoma, Clinical pathology, Prognosis

中图分类号: 

  • R739.8

表1

369例口腔颌面部非霍奇金淋巴瘤的临床特点"

Items Value, n (%)
Gender
    Female 180 (48.8)
    Male 189 (51.2)
Age
    ≥60 years 155 (42.0)
     < 60 years 214 (58.0)
Pathological type
    B-cell 299 (81.0)
    T-cell 70 (19.0)
Ann Arbor stage
    Stage Ⅰ 87 (23.6)
    Stage Ⅱ 151 (40.9)
    Stage Ⅲ 94 (25.5)
    Stage Ⅳ 31 (10.0)
Autoimmune disorders
    Sj?gren syndrome 32 (8.7)
    Rheumatoid arthritis 18 (4.9)
    Cervical lymphadenopathy 247 (66.9)
Clinical subtype
    Mass 283 (76.7)
    Necrotic ulcer 38 (9.8)
    Diffuse tissue swelling 48 (13.0)
Special infection
    HBV 39 (10.6)
    HCV 4 (1.1)
    HIV 0
Elevated LDH 42 (11.4)
B symptoms 40 (10.8)
Bulky disease 23 (6.2)

表2

369例非霍奇金淋巴瘤患者病变部位及主要症状的分布特点"

Lesion location Mass Necrotic ulcer Diffuse tissue swelling Total
Major salivary glands 95 (25.8) 1 (0.3) 3 (0.8) 99 (26.8)
    Parotid gland 73 (19.8) 1 (0.3) 3 (0.8) 77 (20.9)
    Submandibular gland 18 (4.9) 0 0 18 (4.9)
    Sublingual gland 4 (1.1) 0 0 4 (1.1)
Facial and cervical region 72 (19.5) 5 (1.4) 13 (3.5) 90 (24.4)
    Neck 66 (17.9) 3 (0.8) 6 (1.6) 75 (20.3)
    Face 6 (1.6) 2 (0.5) 7 (1.9) 15 (4.0)
Oral cavity 60 (16.3) 28 (7.6) 15 (4.1) 103 (27.9)
    Palate 24 (6.5) 13 (3.5) 7 (1.9) 44 (11.9)
    Buccal mucosa 17 (4.6) 2 (0.5) 0 19 (5.2)
    Mouth floor 3 (0.8) 1 (0.3) 0 4 (1.1)
    Lips 3 (0.8) 3 (0.8) 5 (1.4) 11 (3.0)
    Tongue 1 (0.3) 1 (0.3) 3 (0.8) 5 (1.4)
    Gingiva 12 (2.7) 6 (1.6) 2 (0.5) 20 (5.4)
Maxillofacial bones 39 (10.6) 3 (0.8) 8 (2.2) 50 (13.6)
    Maxilla 16 (4.3) 1 (0.3) 3 (0.8) 20 (5.4)
    Mandible 23 (6.2) 2 (0.5) 4 (1.1) 29 (7.9)
    Zygoma 0 0 1 (0.3) 1 (0.3)
Waldeyer’s ring 14 (3.2) 2 (0.5) 4 (3.2) 20 (4.5)
    Tongue base 6 (1.6) 2 (0.5) 4 (1.1) 12 (3.3)
    Palatine tonsil 8 (2.2) 0 0 8 (2.2)
Infratemporal fossa 3 (0.8) 1 (0.2) 3 (0.8) 7 (1.9)
Total 283 (76.7) 38 (10.3) 48 (13.0) 369 (100.0)

图1

口腔颌面部NHL的三种主要临床表现"

图2

口腔颌面部非霍奇金淋巴瘤的病理表现"

表3

不同病理亚型口腔颌面部NHL患者的年龄及性别分布特征"

Subtype Age/years, ${\bar x}$±s/Median (IOR) Gender, n Total, n(%)
Male Female
B-cell NHL 54.49±20.75 139 160 299 (81.0)
    BL 5.50 (6) 14 2 16 (4.3)
    B-ALL/LBL 8.00 (12) 2 3 5 (1.4)
    CLL/SLL 37.50 2 0 2 (0.5)
    DLBCL 60.98±17.59 61 68 129 (35)
    FL 52.37±15.69 21 20 41 (11.1)
    LPL 56.50 0 2 2 (0.5)
    MALT 52.11±17.06 24 50 74 (20.1)
    MCL 65.42±10.38 6 6 12 (3.3)
    NMZL 63.00 0 1 1 (0.3)
    Plasmacytoma 58.00 (23) 2 2 4 (1.1)
    Unspecified B-cell NHL 61.20±16.15 7 6 13 (3.5)
T-cell NHL 44.95±20.82 41 29 70 (19)
    ALCT 48.63±26.09 4 4 8 (2.2)
    ENKTCL 41.74±18.12 19 12 31 (8.4)
    EBV-TLD 26.00 1 0 1 (0.3)
    PTCL-NOS 52.78±19.19 5 4 9 (2.4)
    SPTCL 12.00 0 1 1 (0.3)
    T-ALL/LBL 24.50 1 1 2 (0.5)
    Unspecified T-cell NHL 50.63±19.59 10 8 18 (4.9)
Total 52.60±21.18 180 189 369 (100.0)

图3

369例口腔颌面部非霍奇金淋巴瘤的生存曲线"

表4

369例NHL患者预后的单因素分析"

Items 1-year OSR/% 2-year OSR/% 5-year OSR/% MST/months Pa HR 95%CI Pb
Gender 0.983 1.003 0.739-1.363 0.810
    Female 90.07 82.25 58.26 86.00
    Male 90.03 82.51 59.54 85.00
Age < 0.001 0.211 0.151-0.295 < 0.001
     < 60 years 96.02 92.95 78.04
    ≥60 years 82.08 68.16 35.26 40.00
Ann Arbor stage < 0.001 6.271 4.499-8.740 < 0.001
    Stage Ⅰ-Ⅱ 96.45 93.15 80.23
    Stage Ⅲ-Ⅳ 78.57 61.73 23.46 33.00
B symptoms 0.029 1.639 1.044-2.574 0.032
    Yes 71.68 65.57 44.65 48.00
    No 92.09 84.26 60.48 93.00
Cervical lymphadenopathy 0.190 1.230 0.900-1.681 0.193
    Yes 90.28 81.34 54.38 82.00
    No 89.75 83.74 64.81 94.00
Bulky disease 0.208 0.713 0.419-1.213 0.212
    Yes 90.90 81.82 48.35 56.00
    No 90.00 82.43 59.71 88.00
Elevated LDH 0.004 1.865 1.215-2.861 0.004
    Yes 84.89 74.43 39.77 40.00
    No 90.71 83.41 61.34 93.00
Lesion location < 0.001 < 0.001
    Major salivary glands 90.76 88.62 76.01 117.00
    Faciocervical regions 90.43 84.16 63.19 93.00 2.183 0.679-7.020
    Oral cavity 88.58 77.63 40.59 51.00 2.847 0.818-9.910
    Maxillofacial bones 89.43 80.70 53.89 75.00 0.907 0.276-2.978
    Waldeyer’s ring 95.00 75.00 50.00 35.00 1.740 0.523-5.792
    Infratemporal fossa 71.43 71.43 71.43 131.00 1.350 0.413-4.409
Pathological type 0.047 0.689 0.476-0.998 0.049
    B-cell NHL 89.96 82.85 62.66 93.00
    T-cell NHL 95.24 80.06 41.41 51.00

图4

受到不同因素影响的NHL患者生存曲线"

表5

369例NHL患者预后的多因素分析"

Items HR 95%CI P
Age 0.262 0.181-0.379 < 0.001
Ann Arbor stage 4.515 3.142-6.488 < 0.001
Elevation of serum LDH 1.724 1.115-2.666 0.014
Pathological type 0.689 0.476-0.998 0.049
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