| Background and PurposePrimary ocular adnexal lymphoma(POAL)is an extranodal lymphoma,wh ich often occurs in the orbit,lacrimal gland,eyelid and conjunctiva,and accou nts for 55%of all ocular adnexal lymphomas.POAL is mainly non-Hodgkin’s lymphoma(NHL).Among the pathological types,mucosa-associated lymphom a lymphoma has the highest incidence,accounting for 62.00%,and its prognos is is significantly better than other pathological types.Follicular lymphoma(FL)is the second most common subtype,accounting for about 17%,followed by diffuse large B cell lymphoma(DLBCL),accounting for about 10%.In the 1970s,the annual incidence of POAL was about 9 per 100,0000,and it has grad ually increased in the past 50 years.The main treatment options for primary o cular adnexal mucosa-associated lymphoma(POAML)include surgery,radiother apy,chemotherapy,immunotherapy and antibiotic therapy.At present,there are still controversies about the treatment strategy of POAML.In this study,we conducted retrospective analysis of POAML patients with different treatment op tions to compare the efficacy and toxic side effects of different treatment optio ns,so as to provide reference value for clinicians.Materials and Methods1.A total of 153 patients with primary ocular adnexal mucosa-associated lymphoid tissue lymphoma patients admitted to the First Affiliated Hospital of Zhengzhou University from January June 2009 to August 2019 were selected.137 patients who received the treatment regimen of surgery,surgery combined with chemotherapy,surgery combined with radiotherapy or surgery combined with chemotherapy and radiotherapy were enrolled.Data of 137 POAML patients were collected and follow-up data were established.2.Clinical characteristics and survival data of 137 patients with POAML were retrospectively studied.The short-term and long-term effects of patients receiving surgical treatment,systemic chemotherapy and radiotherapy alone were compared and analyzed,and the side effects of the three programs were compared.3.Gender,age,Lugano staging,MALT-IPI score,serum LDH level,bone marrow Invasion,monocular or binocular lesion involvement and other characteristics of patients with primary ocular adnexal mucosa-associated lymphoid tissue lymphoma who received surgery alone,surgery combined with chemotherapy,surgery combined with radiotherapy or surgery combined with chemotherapy and radiotherapy were analyzed to search for independent prognostic factors affecting the survival of patients.Statistical methodStatistical software SPSS22.0 was used to analyze the data.The chi-square test,Fisher exact probability and Mann Whitney test were used to compare categorical variables of the groups.The survival rate of the whole group and each subgroup were analyzed by Kaplan-Meier method.The survival difference between four groups were analyzed by Log-rank method.COX proportional hazards regression model was used to analyze the prognostic factors affecting the survival of patients.If the bilateral P value was<0.05,the difference was considered to be statistically significant.Results1.Clinical features:The median age of 137 patients with POAML was 56 years(range:30-82 years).There were 77 males(56.2%)and 60 females(43.8%).Common symptoms of patients include eyelid swelling,exophthalmos,drooping eyelids,blurred vision,etc.The orbit is the most common site of involvement(65 cases,47.4%),followed by conjunctiva(29 cases,21.2%),eyelids(25 cases,18.3%),lacrimal glands(18 cases,13.1%),and ocular sac involvement is less common;Among them,14 cases were binocular disease(10.2%).2.Short-term efficacy:The CR rate of the surgical treatment program,the surgery combined with chemotherapy group,the surgery combined with radiotherapy treatment program and the surgery combined with chemotherapy and radiotherapy group were 84.2%,86.2%,88.9%,91.7%respectively.There was no statistically significant difference between the groups(P=0.331),suggesting there was no difference in the short-term efficacy of the four treatment options.3.Long-term efficacy:The median follow-up time was 78 months(32～127 months).The 10-year PFS rate of 137 POAML cases was 68.5%,and the 10-year OS rate was 85.0%.The 10-year PFS of the surgery+chemotherapy group、surgery+radiotherapy group and surgery+chemotherapy+radiotherapy group were significantly prior than that of the surgery group(78.20%vs 77.90%vs 82.3%vs51.30%,P=0.001),and the difference between the groups was statistically significant.Subgroup analysis showed that among stage Ⅰ-Ⅱ,the 10-year PFS of the surgery combined with chemotherapy group,the surgery combined with radiotherapy treatment program and the surgery combined with chemotherapy and radiotherapy group were significantly prior than that of the surgery group(88.10%vs 79.70%vs 92.9%vs54.50%,P=0.001),and the difference was statistically significant.Among stage Ⅲ-Ⅳ,the 10-year PFS of the surgery+chemotherapy group and the surgery+chemotherapy+radiotherapy group were no statistically significant(47.10%vs57.10%,P=0.518).In the subgroup analysis of patients with stage Ⅲ-Ⅳchemotherapy,the efficacy of the rituximab group was better than that of the non-rituximab group(10-year PFS 55.6%vs 41.7%,P=0.036),4.Side effects:The side effects of surgery usually included local pain and discomfort,decreased vision,damage to the muscles and nerves of the eye leading to eye movement disorders,and ptosis.The adverse reactions of patients in the chemotherapy group were mainly hematological toxicity,such as neutropenia,anemia,and thrombocytopenia.Other non-hematological adverse reactions included digestive tract reactions,liver toxicity,and chemotherapy-related pneumonia.The most common adverse reactions in the radiotherapy group were ocular complications,such as dry eye,inflammation of the eye appendages,cataracts,corneal ulcers,radiation retinopathy,and nasolacrimal duct obstruction.5.Analysis of prognostic factors:Age over 56 years old and bilateral eye involvement may be the independent prognostic factors of primary ocular adnexal mucosa-associated lymphoid tissue lymphoma.Conclusion1.POAML is a relatively indolent lymphoma that progresses slowly and whether chemotherapy or radiotherapy all has a better survival time.2.The clinical effects of surgery+chemotherapy、surgery+radiotherapy and surgery+chemotherapy+radiotherapy are equivalent,and both are better than surgical treatment;the chemotherapy regimen containing rituximab is better than the non-rituximab regimen.3.Adverse events related to chemotherapy can be recovered after stopping chemotherapy and giving relevant symptomatic treatment.There are no chemotherapy-related deaths and no local ophthalmic complications.Most radiotherapy-related side effects are irreversible,and severe cataract complications usually require surgery.4.Age over 56 years old and bilateral eye involvement may be the independent prognostic factors of primary ocular adnexal mucosa-associated lymphoid tissue lymphoma.Therefore,a comprehensive evaluation should be carried out when choosing a treatment plan. |
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