Clinical Characteristics And Prognostic Analysis Of Primary Extranodal Non-hodgkin Lymphoma Of The Head And Neck

Objective:The article aims to explore the clinical characteristics and treatments of primary extranodal non-Hodgkin’s Lymphoma（PE-NHL）arising in head and neck and to investigate the relevant prognostic factors influencing progression free survival（PFS）and overall survival（OS）.Methods:Clinical data of 74 patients newly diagnosed with PE-NHL originating in the head and neck,admitted to the First Hospital of Jilin University,a single center,from February 2012 to February 2022 was collected.Statistics cover gender,gender,age,general status,clinical features,auxiliary examination,pathological and immunohistochemical results,treatment,efficacy and survival status.We used the international prognostic index（IPI）scoring system to stratify the risk groups of all patients and Ann Arbor staging system to determine clinical staging.According to the above indicators,univariate and multivariate analysis was conducted on the prognosis of PE-NHL of the head and neck patients.Result:A total of 74 newly diagnosed PE-NHL of head and neck patients were involved in the study,including 41 males and 33 females,with a male to female ratio of 1.24:1 and a median age of 58.5.The most common site of disease is Waldeyer’s ring（39 cases,52.7%）,followed by nasal cavity（15 cases,20.3%）.Among all patients with PE-NHL of the head and neck,19 patients（25.7%）were associated with B symptom,presented by unexplained weight loss（10% in 6 months）,and/or unexplained fever,and/or night sweat.The clinical manifestations of head and neck PE-NHL varied with the primary site swollen and painful（33 cases,44.6%）the most common.Pharyngeal pain and dysphagia and foreign body sensation of pharynx were the most common on the primary site of the throat,followed by slurred speech and dysphagia,dyspnea and hoarseness.The primary site of the nose and nasopharynx was nasal obstruction.The most common lesion morphology was a mass（53 cases,71.6%）,followed by local ulceration,tumor formation with local ulceration and simple mucosal swelling.Among all 74 patients with head and neck PE-NHL,52 cases were mature B-cell lymphoma and 22 cases were mature NK/T cell lymphoma.Diffuse large B-cell lymphoma was the most common type（38 cases,51.4%）,followed by extranodal NK/T cell lymphoma nasal type（16 cases,21.6%）.In all the 74 cases of PE-NHL patients,62 cases（83.8%）accepted chemotherapy alone,11 cases（14.9%）accepted radiotherapy and chemotherapy combination and 1 case（1.4%）accepted the surgery treatment.After treatment,39 cases（68.4%）of patients achieved complete remission,5 cases（8.8%）of partial remission,7 cases（12.3%）of stable disease,and 6 cases（10.5%）of progressive disease,objective response rate（ORR）was 77.2%.The ORR of the chemotherapy alone group and chemotherapy combined with radiotherapy group were 72.3% and 100%.The median PFS of head and neck PE-NHL is17.5 months,and the median OS was 24.6 months.One-year PFS rate was 76.4%,2-year PFS rate of 67.9%,and 5-year PFS rate of 59.3%.One-year OS rate was 89.4%,2-year OS rate 85.6%,and 5-year OS rate 63.2%.Univariate analysis showed that patients prognosis with ECOG score ≥2,Ann Arbor stage Ⅲ or Ⅳ,elevated LDH level,presense of B symptoms and IPI（international prognostic index）risk stratification as the high-risk group was poorer.Multivariate analysis showed that ECOG score ≥2,Ann Arbor stage Ⅲ or Ⅳand IPI risk stratification as the high risk group were independent risk factors affecting OS prognosis of patients with PE-NHL of the head and neck.Conclusion:（1）PE-NHL of the head and neck is more frequent in patients aged 50–70 years,mostly in males.Clinical manifestations lack specificity.（2）The most common site of head and neck PE-NHL is Waldeyer’s ring,and the most common pathological type is DLBCL.Non-GCB type is more common in patients with Hans type.（3）IPI score has better prognostic value for patients in the high-risk group of head and neck PE-NHL.ECOG score ≥2,Ann Arbor stage Ⅲ or Ⅳ and IPI risk stratification as the high risk group are independent prognostic factors affecting OS.（4）Chemotherapy combined with radiotherapy can achieve better ORR in patients with head and neck PE-NHL.