Clinical Characteristics Of Primary Waldeyer's Ring Non-Hodgkin's Lymphoma And Treatment Pattern,prognostic Analysis Of Primary Waldeyer's Ring Diffuse Large B-cell Lymphoma

Background and ObjectiveWaldeyer's ring is an annular lymphoid tissue containing the tonsils,oropharynx,nasopharyngeal,tongue base,and soft palate.It is a common site of head and neck lymphoma.Regarding the question of whether the Waldeyer's ring should be attributed to internal or external positions,opinions have not been unified so far.Internationally,Waldeyer's ring non-Hodgkin's lymphoma is divided into a group of lymphoid tissue lymphomas that originate from mucosal inflammation.According to the Ann-Arbor staging system,it is assigned to intranodal organs.However,there are also studies that suggest that the anatomic sites and pathological features of the Waldeyer's ring are more characteristic of extranodal lesions.There are some differences in the distribution of disease in Waldeyer's lymphoma.Waldeyer's lymphoma in foreign countries accounts for 5%-10% of all NHL patients.Hodgkin's lymphoma involving this ring is rare.Waldeyer's NHL accounts for 19% of all NHLIn China,accounting for more than half of the primary head and neck extranodal lymphoma.At present,the relevant guidelines suggest that radiotherapy can be used as a clinical treatment option for the treatment of stage I and II DLBCL based on the CHOP regimen with rituximab.NK/T cell lymphoma is treated with chemotherapy and radiotherapy.As the common site of the head and neck lymphoma,the treatment of the Waldeyer's ring is still controversial.To analyze the clinical features of primary Waldeyer's ring non-Hodgkin's lymphoma and explore treatment strategies,efficacy and prognostic factors of DLBCL to raise awareness of non-Hodgkin's lymphoma of the primary Waldeyer's ring.MethodsThe data of 92 patients with primary Waldeyer's ring NHL enrolled from January2010 to January 2017 were collected.Data of patients were collected,including age,gender,clinical manifestations,serum Lactate Dehydrogenase(LDH)level,serum?2-microglobin(?2-MG),therapies,outcomes,and then analyzed survival of patients with DLBCL.ResultsThe 92 patients included in the study had a median age at 49.5 years and the highest prevalence was in the age group of 41 to 50 years,with a ratio of 1.3 to 1 for men and women.The highest proportion of patients with primary tonsils accounted for 63.0%,followed by nasopharynx(21.7%),oropharynx(4.3%),tongue base(5.4%)and soft palate(3.3%).Sore throat,pharyngeal foreign body sensation,nasal congestion as the main clinical manifestations.The most common pathological type was DLBCL.In the early stage of DLBCL(stage?-?),there were 48 cases.There was no significant difference in the CR rate between patients receiving combinedchemoradiotherapy and chemotherapy(P=0.083).The 5-year PFS were 81.5% and68.0% respectivey,while the difference was not statistically significant(P=0.148),the 5-year OS were 92.6% and 73.7% respectively,and the difference was statistically significant(P=0.026).There was no significant difference in CR rate between patients receiving CHOP or CHOP-like ±R regimens and CHOP or CHOP-like ±R sequential DICE±R chemotherapy(P=0.345).There was also no significant difference in 5-year PFS and OS(P=0.525,0.609).There was no significant difference in CR rate between patients with rituximab and those without rituximab(P=0.978).The difference was not statistically significant in 5-year PFS and OS(P=0.779,0.882),but the patients with rituximab had some survival advantages.The 5-year PFS of CR patients and non-CR patients was 86.7% and67.0%,respectively,with significant difference(P=0.017).The 5-year OS was 90.0%and 74.5%,respectively,with significant difference(P=0.023).Univariate analysis showed that age,ECOG score and LDH level were the main factors affecting the prognosis of patients with early DLBCL,and multivariate analysis showed that age and ECOG score were independent prognostic factors.Conclusion1.Primary Waldeyer's ring NHL occurs in middle-aged men,morecommon in women than women,the most common site is tonsil,and the typeof DLBCL is the most common pathological,the clinical manifestations associ-ated with the site of the disease.2.Combined radiochemotherapy has survival benefits for early stage of Waldeyer's ring DLBCL patients.3.It has important influence on prognosis whether CR is achieved after che motherapy in patients with early stage of Waldeyer's ring DLBCL.4.Age,ECOG score and LDH level were the important factors affecting the prognosis of early Waldeyer's ring DLBCL,while,age and ECOG score were independent prognostic factors.