Department of Radiation Oncology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150,China (Wen G,Zhang JSH);Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060,China (Zhang YJ, Li YY, Feng LL, Xia YF);Department of Radiation Oncology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080,China (Niu SHQ)
Abstract:Objective To analyze the clinical features, treatment methods, and prognostic factors for early primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma. Methods A retrospective analysis was performed on the clinical data, treatment outcomes, and survival of 32 patients with early pulmonary MALT lymphoma from March 2001 to September 2013. The median age of those patients was 56 years. Twenty-three patients had stage ⅠE disease and nine had stage ⅡE disease. According to the marginal zone B-cell lymphoma prognostic index (MZLPI), twenty-three patients were scored as 0 and nine as 1. Nine patients received radiotherapy, eight patients underwent surgery alone, three patients underwent surgery plus chemotherapy, and twelve patients received chemotherapy alone. The Kaplan-Meier method was adapted for calculating the OS,PFS and the log-rank test was used for survival difference analysis and univariate prognostic analysis. Results The 5-year sample size was 22. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 84.5% and 73.2%, respectively. Radiotherapy yielded an overall response rate of 100%, including a complete response rate of 66.7% and a partial response rate of 33.3%. The univariate analysis showed that non-radiotherapy treatment was a prognostic factor for poor PFS. The patients treated with radiotherapy had significantly higher 5-year PFS rates than those treated without radiotherapy (100% vs. 63.0%,P=0.029), while there was no significant difference in 5-year OS rate between these two groups (100% vs. 78.8%,P=0.129). Age older than 60 years, an ECOG score of 2, and an MZLPI score of 1 were prognostic factors for poor PFS (P=0.041, 0.018, and 0.044) and OS (P=0.001, 0.001, and 0.003). Conclusions The prognostic factors for early pulmonary MALT lymphoma include age, ECOG score, and MZLPI score. Low-dose involved-field radiotherapy (24–30 Gy) can improve local control and survival.
Wen Ge,Zhang Yujing,Zhang Jinshan et al. Early primary pulmonary mucosa-associated lymphoid tissue lymphoma:a prognostic analysis and literature review[J]. Chinese Journal of Radiation Oncology, 2016, 25(7): 713-717.
[1]Chng WJ,Remstein ED,Fonseca R,et al. Gene expression profiling of pulmonary mucosa-associated lymphoid tissue lymphoma identifies new biologic insights with potential diagnostic and therapeutic applications[J].Blood,2009,113(3):635-645.DOI:10.1182/blood-2008-02-140996 [2]Ferraro P,Trastek VF,Adlakha H,et al. Primary non-Hodgkin′s lymphoma of the lung[J].Ann Thorac Surg,2000,69(4):993-997.DOI:10.1016/S0003-4975(99)01535-0 [3]Zucca E,Conconi A,Pedrinis E,et al. Nongastric marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue[J].Blood,2003,101(7):2489-2495.DOI:10.1182/blood-2002-04-1279 [4]Oh SY,Kwon HC,Kim WS,et al. Nongastric marginal zone B-cell lymphoma:a prognostic model from a retrospective multicenter study[J].Cancer Lett,2007,258(1):90-97.DOI:10.1016/j.canlet.2007.08.012 [5]李爱武,徐建芳,周彩存,等.肺黏膜相关淋巴组织淋巴瘤的临床特征与诊断[J].中华肿瘤杂志,2012,34(5):390-393.DOI:10.3760/cma.j.issn.0253-3766.2012.05.017 Li AW,Xu JF,Zhou CC,et al. Clinical characteristics and diagnosis of pulmonary mucosa-associated lymphoid tissue-derived (MALT) lymphoma:a restrospective analysis of 29 cases[J].Chin J Oncol,2012,34(5):390-393.DOI:10.3760/cma.j.issn.0253-3766.2012.05.017 [6]房辉,李晔雄,宋永文,等.14例肺原发性黏膜相关淋巴组织淋巴瘤疗效分析[J].中华放射肿瘤学杂志,2014,23(1):14-16.DOI:10.3760/cma.j.issn.1004-4221.2014.01.004 Fang H,Li YX,Song YW,et al. Clinical features and treatment outcome of 14 patients with primary pulmonary mucosa-associated lymphoid tissue lymphoma[J].Chin J Radiat Oncol,2014,23(1):14-16.DOI:10.3760/cma.j.issn.1004-4221.2014.01.004 [7]Stefanovic A,Morgensztern D,Fong T,et al. Pulmonary marginal zone lymphoma:a single centre experience and review of the SEER database[J].Leuk Lymphoma,2008,49(7):1311-1320.DOI:10.1080/10428190802064933 [8]Oh SY,Kim WS,Kim JS,et al. Pulmonary marginal zone B-cell lymphoma of MALT type—what is a prognostic factor and which is the optimal treatment,operation,or chemotherapy?:consortium for Improving Survival of Lymphoma (CISL) study[J].Ann Hematol,2010,89(6):563-568.DOI:10.1007/s00277-009-0875-7 [9]Huang H,Lu ZW,Jiang CG,et al. Clinical and prognostic characteristics of pulmonary mucosa-associated lymphoid tissue lymphoma:a retrospective analysis of 23 cases in a Chinese population[J].Chin Med J (Engl),2011,124(7):1026-1030.DOI:10.3760/cma.j.issn.0366-6999.2011.07.015 [10]Raderer M,Streubel B,Woehrer S,et al. High relapse rate in patients with MALT lymphoma warrants lifelong follow-up[J].Clin Cancer Res,2005,11(9):3349-3352.DOI:10.1158/1078-0432.CCR-04-2282 [11]Borie R,Wislez M,Thabut G,et al. Clinical characteristics and prognostic factors of pulmonary MALT lymphoma[J].Eur Respir J,2009,34(6):1408-1416.DOI:10.1183/09031936.00039309 [12]Oh SY,Ryoo BY,Kim WS,et al. Nongastric marginal zone B-cell lymphoma:analysis of 247 cases[J].Am J Hematol,2007,82(6):446-452.DOI:10.1002/ajh.20874 [13]Troch M,Whrer S,Raderer M.Assessment of the prognostic indices IPI and FLIPI in patients with mucosa-associated lymphoid tissue lymphoma[J].Anticancer Res,2010,30(2):635-639 [14]Olszewski AJ,Desai A.Radiation therapy administration and survival in stage Ⅰ/Ⅱ extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue[J].Int J Radiat Oncol Biol Phys,2014,88(3):642-649.DOI:10.1016/j.ijrobp.2013.11.225 [15]Tsai HK,Li S,Ng AK,et al. Role of radiation therapy in the treatment of stage Ⅰ/Ⅱ mucosa-associated lymphoid tissue lymphoma[J].Ann Oncol,2007,18(4):672-678.DOI:10.1093/annonc/mdl468 [16]National Comprehensive Cancer Network,Inc. NCCN clinical practice guidelines in oncology:non-hodgkin’s lymphomas v.2.2014[EB/OL].Fort Washington:NCCN.2014[2014-03-27].http://www.nccn.org/professionals/physician_gls/f_guidelines.asp [17]Girinsky T,Paumier A,Ferme C,et al. Low-dose radiation treatment in pulmonary mucosa-associated lymphoid tissue lymphoma:a plausible approach? A single-institution experience in 10 patients[J].Int J Radiat Oncol Biol Phys,2012,83(3):e385-e389.DOI:10.1016/j.ijrobp [18]Goda JS,Gospodarowicz M,Pintilie M,et al. Long-term outcome in localized extranodal mucosa-associated lymphoid tissue lymphomas treated with radiotherapy[J].Cancer,2010,116(16):3815-3824.DOI:10.1002/cncr.25226 [19]Girinsky T,van der Maazen R,Specht L,et al. Involved-node radiotherapy (INRT) in patients with early Hodgkin lymphoma:concepts and guidelines[J].Radiother Oncol,2006,79(3):270-277.DOI:http://dx.doi.org/10.1016/j.radonc.2006.05.015 [20]Lowry L,Smith P,Qian W,et al. Reduced dose radiotherapy for local control in non-Hodgkin lymphoma:a randomised phase Ⅲ trial[J].Radiother Oncol,2011,100(1):86-92.DOI:http://dx.doi.org/10.1016/j.radonc.2011.05.013.