口腔颌面-头颈部黏膜相关淋巴组织边缘区淋巴瘤临床及预后分析

doi:10.19438/j.cjoms.2019.05.007

摘要/Abstract

摘要： 目的：探讨口腔颌面-头颈部黏膜相关淋巴组织边缘区淋巴瘤（MALT淋巴瘤）的临床特征、分期、治疗方法及预后,为临床治疗提供更强的循证医学证据。方法：回顾分析上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科收治的105例原发于口腔颌面-头颈部的MALT淋巴瘤患者的临床资料,采用SPSS 22.0软件包对其预后进行分析。结果：105例MALT淋巴瘤患者中,男女比例为1∶2.5,中位年龄56岁（18~86岁）。主要临床表现为单纯渐增性肿块,52%的患者有长期口干症状或曾被诊断为自身免疫性疾病或慢性腮腺炎。根据Ann Arbor分期,Ⅰ期48例,Ⅱ期25例,Ⅲ期7例,Ⅳ期25例;有B症状者仅1例,无骨髓受侵的患者。最常见的部位为腮腺、腭、下颌下腺。50例接受单一治疗,49例接受联合治疗。中位随访时间60个月,8例失访,初治后完全缓解率为80%;疾病进展12例,死亡14例。5年总生存期和无进展生存期分别为89%、88%;全身治疗（化疗或利妥昔单抗）可显著提高晚期患者的无进展生存期（P<0.05）,MALT淋巴瘤的国际预后指数（MALT-IPI）是影响总生存期的独立预后因素,Ann Arbor分期是影响无进展生存期的独立预后因素。结论：口腔颌面-头颈部MALT淋巴瘤初治疗效良好,进展缓慢;晚期患者应辅助全身治疗。MALT-IPI和Ann Arbor分期是影响预后的独立因素。

关键词: MALT淋巴瘤, 口腔颌面-头颈部, MALT-IPI, Ann Arbor分期

Abstract: PURPOSE: This retrospective study was performed to explore the clinical profile,staging,treatment and prognosis of extranodal marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) occurring in oromaxillofacial head and neck region, in order to provide more medical evidence for the clinical practice. METHODS: One hundred and five patients with MALT lymphoma occurring in oromaxillofacial head and neck region from the Department of Oromaxillofacial Head and Neck Oncology of Shanghai Ninth People's Hospital were included in this retrospective analysis. SPSS 22.0 software package was used for data analysis. RESULTS: The female-to-male ratio was 2.5∶1. Median age at diagnosis was 56 years (range, 18-86 years). The most common clinical manifestation was progressive swelling of local sites; 52% of patients had long-term xerostomia, confirmed autoimmune diseases or chronic parotitis. According to Ann Arbor staging, 48 patients were in stage Ⅰ, 25 in stage Ⅱ, 7 in stage Ⅲ, 25 in stage Ⅳ. Only one patient had B symptom and no patients had bone marrow involvement. The most common sites were parotid gland, palate and submandibular gland. Fifty patients received single treatment and 49 patients received combined modality treatment.The median follow-up time was 60 months and 8 patients were lost to follow-up. The complete response rate after initial treatment was 80%. Tumor progression was observed in 12 patients and 14 patients died. The 5-year overall survival(OS) and progression-free survival(PFS) were 89% and 88%, respectively. Systemic treatment(chemotherapy or rituximab) was able to significantly improve PFS in patients with disseminated disease(P<0.05). MALT-IPI was an independent prognostic factor affecting OS and Ann Arbor staging affecting PFS. CONCLUSIONS: The outcome of initial treatment is satisfactory and the disease progresses slowly. Systemic therapy may improve PFS in patients with disseminated disease. MALT-IPI and Ann Arbor staging are independent prognostic factors.

Key words: MALT lymphoma, Oromaxillofacial head and neck region, MALT-IPI, Ann Arbor staging

中图分类号:

R739.8

张湉, 吴云腾, 郭伟. 口腔颌面-头颈部黏膜相关淋巴组织边缘区淋巴瘤临床及预后分析[J]. 中国口腔颌面外科杂志, 2019, 17(5): 424-430.

ZHANG Tian, WU Yun-teng, GUO Wei. Clinical and prognostic analysis of extranodal marginal zone B cell lymphoma of mucosa-associated lymphoid tissue occurring in oromaxillofacial head and neck region[J]. China J Oral Maxillofac Surg, 2019, 17(5): 424-430.

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