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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (1): 13-21. doi: 10.19723/j.issn.1671-167X.2023.01.003

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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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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

CLC Number: 

  • R739.8

Table 1

Clinicopathologic features of 369 patients with oral and maxillofacial non-Hodgkin lymphoma"

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)

Table 2

Distribution pattern of lesion location and primary symptoms of 369 non-Hodgkin lymphoma patients  n(%)"

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)

Figure 1

Main clinical manifestations of oral and maxillofacial NHL A, patient diagonased with mantle cell lymphoma (arrow, NHL presenting as a mass); B, patient diagonased with extranodal natural killer/T-cell lymphoma nasal type (arrow, NHL presenting as a necrotic ulcer); C, patient diagonased with diffuse large B-cell lymphoma (arrow, NHL presenting as the diffuse tissue swelling). NHL, non-Hodgkin lymphoma."

Figure 2

Pathological manifestations of oral and maxillofacial non-Hodgkin lymphoma A, diffuse large B-cell lymphoma (HE ×400); B, extranodal marginal zone lymphoma of mucosa associated lymphoid tissue (HE ×400); C, follicular lymphoma (HE ×400); D, Burkitt lymphoma (HE ×400); E, extranodal natural killer/T-cell lymphoma, nasal type (HE ×400); F, anaplastic large cell lymphoma(HE ×400)."

Table 3

Age and gender characteristics of different subtypes of oral and maxillofacial NHL patients"

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)

Figure 3

Survival curve of 369 cases with oral and maxillofacial non-Hodgkin lymphoma"

Table 4

Univariate analysis of prognosis associated with 369 cases of NHL patients"

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

Figure 4

Survival curves of NHL patients based on different factors influencing the prognosis LDH, lactate dehydrogenase; NHL, non-Hodgkin lymphoma."

Table 5

Multifactorial analysis of prognosis associated with 369 cases of NHL patients"

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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