口腔颌面部弥漫大B细胞淋巴瘤的临床特征及预后分析

Clinical features and prognostic analysis of diffuse large B-cell lymphoma in oral cavity and maxillofacial region

目的:分析口腔颌面部弥漫大B细胞淋巴瘤(OC-MR DLBCL)患者临床特征,探讨其预后及可能影响因素。方法:回顾性收集2015年1月—2022年3月收治的60例OC-MR DLBCL患者临床资料,并与67例非OC-MR DLBCL患者进行比较。Kaplan-Meier法计算生存率,log-rank检验和Cox回归模型进行单因素及多因素生存预后分析。结果:60例OC-MR DLBCL患者中,男41例,女19例,中位年龄64岁;non-GCB型占71.4%,Ann ArborⅠ/Ⅱ期占58.3%,60.0%患者属于IPI评分(0~2分)低危组。OC-MR DLBCL与非OC-MR DLBCL患者比较,性别、年龄及Hans分类分布差异无统计学意义,但Ⅲ/Ⅳ期及IPI高危患者占比均较低(P<0.05)。OC-MR DLBCL患者ORR为91.7%,其中CR率60.0%,1年OS率为91.3%,2年OS率为63.6%;非OC-MR患者ORR为88.0%,CR率53.0%,1年OS率为89.6%,2年OS率为75.6%。OC-MR与非OC-MR组DLBCL患者间OS及PFS比较,差异无统计学意义(P>0.05)。生存分析显示IPI评分高危及起病于非韦氏环的OC-MR DLBCL患者预后不良,IPI是影响OS及PFS的独立预后因素(P<0.05)。非OC-MR组患者生存较韦氏环起病患者差,优于非韦氏环者,但均差异无统计学意义(P>0.05)。结论:OC-MR DLBCL患者有特异性临床特征,多数处于早期及低危状态,整体预后不优于非OC-MR DLBCL。IPI及不同起病部位是影响OC-MR DLBCL预后的重要因素。

Objective:To analyze the clinical features and explore the prognosis factors of patients with diffuse large B-cell lymphoma of oral cavity and maxillofacial region(OC-MR DLBCL).Methods:The clinical data of 60 DLBCL patients in OC-MR and 67 DLBCL patients in non-OC-MR was collected retrospectively.All patients were treated at Shanghai Ninth People’s Hospital between January 2015 and March 2022.Kaplan-Meier method was used to calculate survival rates,and the prognostic factors for survival were analyzed by using the log-rank univariate test and the Cox regression multivariate model.Results:In this study,60 OC-MR DLBCL patients with a median age of 64 years old were recruited,including 41 males and 19 females.The non-Germinal center B-cell-like(non-GCB)immunopheno type accounted for 71.4%in OC-MR DLBCL,Ann Arbor stageⅠ/Ⅱaccounted for 58.3%,and the low-risk IPI(score 0-2)accounted for 60.0%.Compared with non-OC-MR DLBCL patients,there were no significant differences in gender,age,and Hans classification distribution,while the Ann Arbor stageⅠ/Ⅱ,normal LDH,and low-risk IPI were more often in OC-MR DLBCL(P<0.05).The objective response rate(ORR)and complete response(CR)rate for OC-MR DLBCL were 91.7%and 60.0%,The 1-year overall survival(OS)rate and 2-year OS rate were 91.3%and 63.6%.The ORR and CR for non-OC-MR DLBCL were 88.0%and 53.0%,the 1-year OS and 2-year OS were 89.6%and 75.6%.There were no significant difference in OS and progression-free survival(PFS)between OC-MR and non-OC-MR(P>0.05).Survival analysis showed that OC-MR DLBCL with high-risk IPI or disease originated in non-Waldeyer’s ring had a poorer prognosis,high-risk IPI was the independent prognostic indicator(P<0.05).The DLBCL of non-OC-MR had an inferior survival when compared to Waldeyer’s ring originated DLBCL,but better than non-Waldeyer’s ring originated OC-MR DLBCL,even though no significant differences(P>0.05).Conclusion:OC-MR DLBCL patients display distinct clinical features,most of them are in an early and low-risk state.While the overall prognosis is not superior to non-OC-MR DLBCL.IPI and different primary sites of OC-MR seem to be important factors for prognosis of patients.