Comparison of clinical characteristics and prognoses between primary Waldeyer′s ring diffuse large B-cell lymphoma and extranodal nasal-type NK/T-cell lymphoma
WU Run-ye*, LI Ye-xiong, WANG Wei-Hu, JIN Jing, WANG Shu-lian, LIU Yue-ping, SONG Yong-wen, REN Hua, FANG Hui, LIU Qing-feng, WANG Zhao-yang, QI Shu-nan, LU Ning-ning, CHEN Bo, ZHANG Xi-mei, ZHOU Li-qiang, LIU Xin-fan, YU Zi-hao
*Departments of Radiation Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021,China
Corresponding author:LI Ye-xiong
Objective This study aimed to compare the clinical characteristics and prognoses of primary Waldeyer′s ring diffuse large B-cell lymphoma (DLBCL) and extranodal nasal-type NK/T-cell lymphoma (ENKTCL). Methods From 2000 to 2008, 122 patients with primary Waldeyer′s ring DLBCL and 44 patients with primary Waldeyer′s ring ENKTCL consecutively diagnosed were retrospectively compared. Patients with DLBCL usually received 4－6 cycles of CHOP-based chemotherapy followed by involved-field radiotherapy. Patients with early stage ENKTCL usually received extended-field radiotherapy with or without subsequent chemotherapy, or short courses (1－3 cycles) of chemotherapy followed by radiotherapy. Kaplan-Meier method was used for survival analysis. Logrank method was used for univariate analysis. Results The follow-up rate was 82%. The number of patients followed 5 years were 32 and 15 in DLBCL and ENKTCL. DLBCL mainly presented with stage Ⅱ tonsillar disease with regional lymph nodeinvolvement. ENKTCL occurred predominately in young males, as nasopharyngeal stageⅠ disease with B symptoms and involving adjacent structures. The 5-year overall survival (OS) and progression-free survival(PFS) rates were 74% and 67% in DLBCL, and 68% and 59% in ENKTCL (χ2=0.53,1.06,P=0.468,0.303), respectively. In stage Ⅰ and Ⅱ diseases, the 5-year OS and PFS rates were 79% and 76% forDLBCL compared to 72% and 62% for ENKTCL (χ2=1.20,2.46,P=0.273,0.117). On univariate analysis, age>60 years, elevated lactate dehydrogenase, eastern cooperative oncology group performance status>1, international prognosis index (IPI) score ≥1, stage Ⅲ/IV diseases and bulky disease were associated with unfavorable survival for DLBCL (χ2=9.40,12.72,6.15,10.36,12.48,5.53,P=0.002,0.000,0.013,0.001,0.000,0.019), and only age>60 years and IPI score ≥1 were associated with poor survival for ENKTCL (χ2=3.98,8.41,P=0.046,0.004). Conclusions These results indicate that remarkable clinical disparities exist between DLBCL and ENKTCL in Waldeyer′s ring. Different treatment strategies for each can result in similarly favorable prognoses.
WU Run-ye*,LI Ye-xiong,WANG Wei-Hu et al. Comparison of clinical characteristics and prognoses between primary Waldeyer′s ring diffuse large B-cell lymphoma and extranodal nasal-type NK/T-cell lymphoma[J]. Chinese Journal of Radiation Oncology, 2012, 21(3): 231-234.
[1] Shih LY, Liang DC. Non-Hodgkin′s lymphoma in Asia. HematolOncol Clin North Am,1991,5:983-1001. [2] Ko YH, Kim CW, Park CS, et al. REAL classification of malignant lymphomas in the Republic of Korea:incidence of recently recognized entities and changes in clinicopathologic features. Hematolymphoreticular study group of the Korean society of pathologists. Revised European-American lymphoma. Cancer,1998,83:806-812. [3] 李晔雄,高远红,袁智勇,等.国际预后指数在韦氏环非霍奇金淋巴瘤的预后意义.中华放射肿瘤学杂志,2002,11:105-110. [4] Ezzat AA, Ibrahim EM, El Weshi AN, et al. Localized non-Hodgkin′s lymphoma of Waldeyer′s ring:clinical features, management, and prognosis of 130 adult patients. Head Neck,2001,23:547-558. [5] Li YX, Liu QF, Fang H, et al. Variable clinical presentations of nasal and Waldeyer ring natural killer/T-cell lymphoma. Clin Cancer Res,2009,15:2905-2912. [6] 黄生富,张兰芳,何侠,等. 咽淋巴环非霍奇金淋巴瘤的影像学特征及临床意义.癌症,2004,23:1325-1328. [7] Ko YH, Lee JD, Kim CM, et al. Malignant lymphomas of the nasal cavity and Waldeyer′s ring—clinicopathologic and immunohistochemical study. J Korean Med Sci,1992,7:314-324. [8] Harabuchi Y, Tsubota H, Ohguro S, et al. Prognostic factors and treatment outcome in non-Hodgkin′s lymphoma of Waldeyer′s ring. Acta Oncol,1997,36:413-420. [9] Laskar S, Muckaden MA, Bahl G, et al. Primary non-Hodgkin′s lymphoma of the nasopharynx:prognostic factors and outcome of 113 Indian patients. Leuk Lymphoma,2006,47:2132-2139. [10] Mohammadianpanah M, Daneshbod Y, Ramzi M, et al. Primary tonsillar lymphomas according to the new world health organization classification:to report 87 cases and literature review and analysis. Ann Hematol,2010,89:993-1001. [11] Cheson BD, Horning SJ, Coiffier B, et al. Report of an international workshop to standardize response criteria for non-Hodgkin′s lymphomas. J Clin Oncol,1999,17:1244-1253. [12] López-Guillermo A, Colomo L, Jiménez M, et al. Diffuse large B-cell lymphoma:clinical and biological characterization and outcome according to the nodal or extranodal primary origin. J Clin Oncol,2005,23:2797-2804. [13] Kim TM, Lee SY, Jeon YK, et al. Clinical heterogeneity of extranodal NK/T-cell lymphoma, nasal type:a national survey of the Korean cancer study group. Ann Oncol,2008,19:1477-1484. [14] 亓殊楠,李晔雄,刘清峰,等.99例结外弥漫性大B细胞淋巴瘤的治疗结果.中华放射肿瘤学杂志,2009,18:101-104. [15] Qi SN, Li YX, Wang H,et al. Diffuse large B-cell lymphoma:clinical characterization and prognosis of Waldeyer′s ring versus lymph node presentation. Cancer,2009,115:4980-4989. [16] Laskar S, Bahl G, Muckaden MA, et al. Primary diffuse large B-cell lymphoma of the tonsil:is a higher radiotherapy dose required? Cancer,2007,110:816-823. [17] Li YX, Fang H, Liu QF, et al. Clinical features and treatment outcome of nasal-type NK/T-cell lymphoma of Waldeyer′s ring. Blood,2008,112:3057-3064. [18] Li YX, Yao B, Jin J, et al. Radiotherapy as primary treatment for stage ⅠE and ⅡE nasal natural killer/T-cell lymphoma. J Clin Oncol,2006,24:181-189. [19] Picker LJ, Butcher EC. Physiological and molecular mechanisms of lymphocyte homing. Annu Rev Immunol,1992,10:561-591. [20] Pals ST, de Gorter DJ, Spaargaren M. Lymphoma dissemination:the other face of lymphocyte homing. Blood,2007,110:3102-3111. [21] Coiffier B, Brousse N, Peuchmaur M, et al. Peripheral T-celllymphomas have a worse prognosis than B-cell lymphomas:a
prospective study of 361 immunophenotyped patients treated with the LNH-84 regimen. Ann Oncol,1990,1:45-50. [22] Morabito F, Gallamini A, Stelitano C, et al. Clinical relevance of immunophenotype in a retrospective comparative study of 297 peripheral T-cell lymphomas, unspecified, and 496 diffuse large B-cell lymphomas:experience of the intergroup Italian Linformi. Cancer,2004,101:1601-1608. [23] 邹国荣,张玉晶,谢方云,等.早期鼻咽非霍奇金淋巴瘤:不同免疫表型的预后差异和治疗对策分析.癌症,2006,25:1543-1549. [24] Lee HK, Wilder RB, Jones D, et al. Outcomes using doxorubicin-based chemotherapy with or without radiotherapy for early-stage peripheral T-cell lymphomas. Leuk Lymphoma,2002,43:1769-1775. [25] Weisenburger DD, Savage KJ, Harris NL, et al. Peripheral T-cell lymphoma, not otherwise specified:a report of 340 cases from the international peripheral T-cell Lymphoma project. Blood,2011,117:3402-3408.
2012, Vol. 21 
