두경부영역의악성림프종 태경 1 이형석 1 서인석 1 이용섭 1 조석현 1 최정혜 2 안명주 2. Hodgkin s and Non-Hodgkin s Lymphoma of Head and Neck

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1 KISEP Head and Neck Korean J Otolaryngol 2003;46: 한양대학교의과대학이비인후과학교실, 1 내과학교실 2 태경 1 이형석 1 서인석 1 이용섭 1 조석현 1 최정혜 2 안명주 2 Hodgkin s and Non-Hodgkin s Lymphoma of Head and Neck Kyung Tae, MD 1, Hyung Seok Lee, MD 1, In Seok Seo, MD 1, Yong Sup Lee, MD 1, Seok Hyun Cho, MD 1, Jung Hye Choi, MD 2 and Myung Ju Ahn, MD 2 1 Department of Otolaryngology and 2 Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea ABSTRACT Background and Objectives:There are considerable geographic and ethnic differences in the incidence, age distribution, and histologic subtypes of lymphoma. There are differences in outcomes of treatment and prognosis according to the stage, age, primary site, serum LDH, and performance status. We performed this study to investigate the outcomes of treatment, prognostic factors, and differences between Hodgkin s disease (HD) and non-hodgkin s lymphoma (NHL). Materials and Method:A retrospective review was made of 84 malignant lymphoma patients involving the head and neck treated between 1993 and 2000 with chemotherapy or combined modality therapy at Hanyang University Hospital. Results:Among 84 patients included in the study, 68 had NHL and 16 had HD. The median age of patients at diagnosis was 55 and 43 for patients of NHL and HD, respectively. Male patients made up 56% of the NHL patients and 75% of the HD patients. The most common extranodal site of NHL was palatine tonsil (16.2%). The most common histologic subtype was diffuse large cell lymphoma (64.7%) in NHL and mixed cellularity (43.8%) in HD. The useful prognostic factors predicting overall survival were stage, histologic subtype, serum LDH, and performance status for NHL, and age for HD. Conclusion:Although the characteristics of malignant lymphoma in Korea differed from those in the western countries, International Prognostic Index (IPI) still proved useful. (Korean J Otolaryngol 2003; 46:324-30) KEY WORDS:Lymphoma Prognosis Hodgkin disease Head and neck neoplasms. 324

2 태경외 (No) Table 1. Primary site of non-hodgkin s lymphoma of head and neck Nodal only Extranodal Tonsil Nasal cavity Nasopharynx Orbit Skin Paranasal sinus Salivary gland Hard palate Brain Gingiva Table 2. Clinical presentation of malignant lymphoma of head and neck (Age) Fig. 1. Age distribution of malignant lymphoma. Number n= % % % 5 7.2% 4 5.9% 2 2.9% 2 2.9% 1 1.5% 1 1.5% 1 1.5% 1 1.5% 1 1.5% NHL (n=68) HD (n=16) Presentation NHL n=68 HD n=16 Neck mass % % B symptom % 08 50% Sore throat % Nasal obstruction % Dysphagia % Ear fullness % NHLnon-Hodgkin s lymphoma, HDHodgkin s disease 325

3 Table 3. Stage on presentation in malignant lymphoma of head and neck NHL n=68 HD n=16 Stage % % Stage % % Stage % % Stage % 1 6.3% NHLnon-Hodgkin s lymphoma, HDHodgkin s disease Table 5. Histologic classification of HD Rye s classification Rye s classification Number n=16 Lymphocyte predominence 1 6.3% Nodular sclerosis % Mixed cellularity % Lymphocyte depletion % HDHodgkin s disease Table 4. Histologic classification of NHL NCI Working Formulation NCI Working Formulation Number n=68 Low grade % Small lymphocytic % Follicular small cell % Follicular mixed small and large cell % Intermediate grade % Follicular large cell % Diffuse small cell % Diffuse mixed small and large cell % Diffuse large cell % High grade % Immunoblastic % Lymphoblastic % Small noncleaved cell % NHLnon-Hodgkin s lymphoma Korean J Otolaryngol 2003;46:324-30

4 태경외 Table 6. Comparison of complete response according to patient characteristics in NHL Characteristics No. of patients No. of complete response % Total % Age % % Sex Male % Female % Histologic grade Low % Intermediate & high % Stage* & % & % B symptom No % Yes % LDH level Normal % High % Performance status ECOG* % % Therapy Chemotherapy % Combined therapy % p0.05, NHLnon-Hodgkin s lymphoma - Table 7. Comparison of complete response according to patients characteristics in HD Characteristics No. of patients No. of complete response % Total % Age % % Sex Male % Female % Histologic grade Lymphocyte predominant % Nodular sclerosis % Mixed cellularity % Lymphocyte depletion % Stage* & % & % B symptom No % Yes % LDH level Normal % High % Performance status ECOG % % Therapy Chemotherapy % Combined therapy % p0.05, HDHodgkin s disease 327

5 (Survival rate) Table 8. Univariate analysis of prognostic factors influencing overall survival rate in patients with NHL (p>0.05) Factors overall survival rate % p-value Stage % 39.3% Serum LDH 0.01 Normal 80.3% Abnormal 49.5% Histologic grade 0.02 Low 100% Intermediate & high 54.8% ECOG performance % % NHLnon-Hodgkin s lymphoma HD (83.3%) NHL (62.2%) (Months) Fig. 2. Overall survival of malignant lymphoma. Group HD NHL Korean J Otolaryngol 2003;46:324-30

6 태경외 Table 9. Multivariate analysis of prognostic factors influencing overall survival rate in patients with NHL Factors Overall survival Odd ratio 95% CI p-value Stage Serum LDH Normal 1 Abnormal Histologic grade 0.97 Low 1 Intermediate & high ECOG performance NHLnon-Hodgkin s lymphoma, CIconfidence interval 329

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