Analysis Of Primary Extranodal Non-Hodgkin Lymphomas Of The Oral Cavity

PART I Clinical Analysis of Primary Oral Extranodal Non-Hodgkin LymphomasObjectivePrimary extranodal non-Hodgkin lymphoma of the oral cavity is a relatively uncommon disease. The purpose of this study is to to describe the clinical features, behavior, and outcome of the disease.35 patients with oral primary extranodal-NHL have been studied for the distribution of gender, age, oral subsite, histological subtype, Ann Arbor clinical stage, the International Prognostic Index,treatment, and follow-up.Materials and methodsDuring the period January 2000 to January 2013, a total number of 35 patients diagnosed as primary oral extra-nodal Non Hodgkin’s Lymphoma were registered at the provincial hospital affiliated to Shandong University. All of them have been studied for the distribution of gender, age, location of lesion in oral cavity, and presenting complaint, histological subtype according to the WHO classification, clinical stage of disease on presentation, the International Prognostic Index, modes of treatment, and follow-up. All baseline investigations like physical and laboratory examination, CT thorax and Ultrasonic examination of abdomen and lymph node were carried out for staging. Overall survival time was measured from the initial diagnosis until death or end of follow-up. Statistical analysis was carried out with the SPSS 20 statistical analysis software,Kaplan-Meier curves were plotted and differences between the curves were analysed with the Mantel-Cox statistics, regarding P-values below 0.05 as significant.ResultsDuring the 13 years,we were able to identify 35 cases of primary Oral Extra-nodal NHL. The majorities were males (19 cases) and the rest were females (16 cases), with a male:female ratio of 1.2:1. Their ages ranged from 3 to 77 years old, with a mean age of 51.7 years and median age of 56 years. The peak incidence age of male were 50-60 years old, female incidence peak in the 50-70 years old.The parotid glands (9 cases) was the most commonly involved site. The most common clinical symptoms of those patients were suddenly appeared and gradually increased soft tissue mass.The most common type was diffuse large B cell lymphoma, accounting for 68.6%(24/35).25 patients were given chemotherapy,7 patients received combination of chemotherapy and radiotherapy,3 patients gave up treatment.CHOP (Cyclophosphamide, hydroxydaunorubicin, vincristine, prednisone) was the most common regimen offered to these patients.Based on the Ann Arbor clinical staging criteria for clinical staging:stage IE 9 patients, stage HE 12 patients, stage ⅢE 11 cases, stage IV 3 patients.The prognosis of patients with stage IE were better than other stage patients, but there was no significant difference on overall comparison.Based on the International Prognostic Index for staging:low risk type(Score 0-1) had a total number of 20 patients;low-intermediate risk type (Score 2) had 6 patients; high-intermediate risk type (Score 3) had 5 patients; high risk type(Score 4-5) had 4 patients. Mantel-cox overall comparison giving the P value was 0.008, there was a significant difference between groups.The prognosis of patients receiving combined treatment(chemotherapy and radiotherapy) was slightly better than chemotherapy group,but their statistical overall comparison showed no significant difference.There was also no significant difference in survival time between patients with bone versus soft tissue localization. The survival times between male and female also showed no significant difference.ConclusionsThe extranodal Non-Hodgkin’s lymphoma of the oral cavity generally appeared as a painless swelling and occured in elderly men mostly. The parotid glands were the most frequent site of involvement. The most common pathological type was diffuse large B cell lymphoma. Most patients were given chemotherapy. There was statistically significant difference between groups classified according to the International Prognostic Index.The extranodal Non-Hodgkin’s lymphoma of the oral cavity generally appeared as a painless swelling and occured in elderly men mostly. The parotid glands were the most frequent site of involvement. The most common pathological type was diffuse large B cell lymphoma. Most patients were given chemotherapy. There was statistically significant difference between groups classified according to the International Prognostic Index.PART Ⅱ The Immunohistochemistry Classification of Primary Diffuse Large B-Cell Lymphoma of the Oral CavityObjectivePrimary extranodal non-Hodgkin lymphoma of the oral cavity are rare and the most common type is diffuse large B-cell lymphoma.Based on gene expression profiles and by immunohistochemical expression of CD10, BCL6 and MUM-1,DLBCL can be divided into germinal center B-cell like(GCB) and non-germinal center B-cell like (non-GCB) subtypes.The prognosis of GCB patients are usually better than non-GCB patients.We undertook this study in order to subclassify primary oral DLBCLs into different prognostic subgroups according to immunohistochemical classification,Ann Arbor clinical stage and the International Prognostic Index.Materials and methodsDuring the period of January 2000 to January 2013,We identified 24 patients diagnosed as primary oral DLBCL from our hospital. All of the expression levels of CD3, CD10, CD20, BCL-6, MUM1 were detected through immunohistochemical method.The patients were classified as GCB and non-GCB subtypes by Hans classification system.The clinical data and follow-up of the patients were collected for analysis.Kaplan-Meier curves were plotted and differences between the curves were analysed with the Mantel-Cox statistics, regarding P-values below 0.05 as significant.ResultsA total number of 24 patients included 11 males and 13 females.Their ages ranged from 17 to 77 years old, with a mean age of 58.1 years.The parotid glands(20.8%) were the most common involved sites.8 cases were disease free survival,5 patients were alive with disease,7 patients died and 4 patients were lost to follow-up.16 cases were sub-classified as non-GCB subgroup and 8 cases as GCB subgroup.The complete remission rate and the 3-year overall survival rate for the GCB group were 62.5% and 87.5% compared with only 42.9% and 37.5% for the non-GCB group. Compared with non-GCB group,GCB group had significantly better survival curves, Mantel-cox overall comparison giving the P value was 0.027.There was also a significant survival difference between groups classified based on the International Prognostic Index(P value was 0.022).But the survival times between males and females,CHOP and R-CHOP schemes, Ann Arbor clinical stage groups all showed no significant difference.ConclusionsThe parotid glands were the most common site for the occurrence of primary oral DLBCL which pre-dominantly belonged to the non-GCB subgroup.The remission rate and survival time after treatment for the GCB group were all better than the non-GCB group. There was statistically significant difference between groups classified according to the International Prognostic Index.PART Ⅲ Effects of radiotherapy in treatment of mucosa-associated lymphoid tissue lymphoma of the salivary glands:a systematic reviewObjectiveTo assess the recent effect and long-term survival of radiotherapy in the treatment of salivary mucosa-associated lymphoid tissue lymphoma.MethodsWe performed literature retrieval in MEDLINE, EMBASE, CENTRAL, CBM, CNKI, Wan Fang and VIP database for clinical research about radiotherapy treating salivary mucosa-associated lymphoid tissue lymphoma. After data extraction, Meta-analysis was conducted by RevMan 5.3 software. Survival analysis was carried out by Kaplan-Meier statistical methods and differences between the curves were analysed with the Mantel-Cox statistics, regarding P-values below 0.05 as significant.Results1. A total of 11 studies reported the treatment evaluation of patients. The complete remission rates were compared by Meta analysis between radiotherapy with chemotherapy, simple operation and combined treatment (chemotherapy and radiotherapy) group which were not significantly different (P=0.17、0.85、0.95 respectively).2. The overall survival of patients were compared by Kaplan-Meier analysis between radiotherapy with chemotherapy, simple operation and combined treatment (chemotherapy and radiotherapy) group. There was no obvious difference between them (P= 0.867、0.541,0.794 respectively).3. The progression free survival of patients were compared by Kaplan-Meier analysis between groups. Radiotherapy group was better than chemotherapy group,but their Mantel-cox overall comparison showed no significant difference(P=0.094) Compared with simple operation group, Radiotherapy group had significantly better progression free survival, Mantel-cox overall comparison giving the P value was 0.043 which mean a significant difference. The progression free survival between radiotherapy and combined treatment (chemotherapy and radiotherapy) group showed no significant difference(P=0.73).ConclusionsIn the treatment of salivary mucosa-associated lymphoid tissue lymphoma, compared with chemotherapy, simple operation and combined treatment (chemotherapy and radiotherapy) group,the patients receiving radiotherapy had no obvious difference in complete remission rate and overall survival. Patients in radiotherapy group had better progression free survival than chemotherapy and simple operation group. Compared with other treatment, radiotherapy could decrease lymphoma recurrence and prolong patient’s progression free survival.