口腔颌面部弥漫大B细胞淋巴瘤69例临床病理分析

Diffuse large B-cell lymphoma of the oral cavity： a clinicopathological analysis of 69 cases

目的探讨口腔颌面部弥漫大B细胞淋巴瘤（DLBCL）的临床病理学特点及其预后相关因素。方法对69例口腔颌面部DLBCL进行回顾性临床病理分析，包括形态学复习、免疫表型和EB病毒编码小RNA（EBV—EBER）原位杂交检测，结合临床随访结果进行预后相关因素分析，并与同期诊断的40例原发淋巴结DLBCL进行比较。结果69例口腔颌面部DLBCL患者中位发病年龄61岁（4—91岁），男女比例为1．56：1。发病部位以舌根最为常见（19例，27．5％），其次为腮腺、齿龈、腭等。肿瘤细胞多起源于非生发中心B细胞，比例为64．2％（43／67），bcl-2、c—myc及EBV—EBER阳性率分别为66．7％（38／57）、23．4％（11／47）及5．3％（3／57），Ki-67高表达（t〉70％）者占71．0％（49／69）。42例获得完整随访资料，生存时间1—85个月，生存分析显示年龄I〉65岁、Ki-67高表达者预后差，R-CHOP方案治疗组预后好于CHOP方案及放疗组。与同期诊断为原发淋巴结DLBCL相比，除了肿瘤细胞的起源分组有明显差异外，其余临床病理特点及预后差异均无统计学意义（均P〉0．05）。结论口腔颌面部DLBCL最常见于舌根，多为非生发中心B细胞起源，临床病理特点及预后与淋巴结DLBCL相似。年龄≥65岁和Ki．67高表达是独立的预后不良提示因素。R—CHOP方案治疗组预后好于CHOP方案治疗组。

Objective To investigate the clinicopathological features and prognostic factors in patients with diffuse large B-cell lymphoma （DLBCL） of the oral cavity. Methods 69 cases of oral DLBCL were collected and retrospectively studied by analyzing their histological features, immunohistoehemical expression, EBV infection and clinical manisfestation. 40 cases of nodal DLBCL, diagnosed during the same period, were collected and compared with the oral DLBCL in clinieopathological and clinical aspects. Results The median age of the patients was 61 years old （4-91 years old）. The ratio of male to female was 1.56：1. The most commonly involved site was root of tongue （27.5 %）, followed by parotid glands, gingiva and palate. Immunohistochemical examination of GCET-1, CD10, bcl-6, MUM-l, and FOXP-1 determined that 64.2 % （43/67） of the cases exhibited non-GCB subtype. The expression of bcl-2, c-myc and EBV-EBER were 66.7 % （38/57）, 23.4 %.（11/47） and 5.3 % （3/57） respectively. Ki-67 I〉70 % was observed in 49 cases （71.0 %）. Follow-up data were obtained in 42 cases, whose overall survival （OS） ranged from 1 to 85 months. Patients with age older than 65 years old, Ki-67 ≥ 70 %, as well as lack of the combination of rituximab with CHOP chemotherapy showed a significant shorter OS. By comparison with the nodal DLBCL, oral DLBCL exhibited a significant decreased proportion of non-GCB subtype, while no significant difference of other elinicopathological features and prognosis were presented. Conclusions The most frequently involved site of oral DLBCL is root of tongue. The majority of cases show non-GCB immunophenotype. Age （older than 65 years old） and Ki-67≥ 70 % are associated with poor prognosis. Immunochemotherapy may prolong OS of these patients.