KISEP Head and Neck Korean J Otolaryngol 2003;46:324-30 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
태경외 - - - - - (No) 20 15 10 15 10 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 10 20 30 40 50 60 70 80 90 (Age) Fig. 1. Age distribution of malignant lymphoma. Number n=68 39 57.4% 29 42.6% 11 16.2% 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 39 57.4% 13 81.3% B symptom 20 29.4% 08 50% Sore throat 12 17.6% Nasal obstruction 09 13.2% Dysphagia 08 11.8% Ear fullness 03 04.4% NHLnon-Hodgkin s lymphoma, HDHodgkin s disease 325
Table 3. Stage on presentation in malignant lymphoma of head and neck NHL n=68 HD n=16 Stage 1 15 22.1% 2 12.5% Stage 2 27 39.7% 7 43.7% Stage 3 15 22.1% 6 37.5% Stage 4 11 16.1% 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 6 37.5% Mixed cellularity 7 43.8% Lymphocyte depletion 2 12.5% HDHodgkin s disease Table 4. Histologic classification of NHL NCI Working Formulation NCI Working Formulation Number n=68 Low grade 11 16.2% Small lymphocytic 05 07.4% Follicular small cell 02 02.9% Follicular mixed small and large cell 04 05.9% Intermediate grade 52 76.5% Follicular large cell 01 01.5% Diffuse small cell 01 01.5% Diffuse mixed small and large cell 06 08.8% Diffuse large cell 44 64.7% High grade 05 07.4% Immunoblastic 02 02.9% Lymphoblastic 02 02.9% Small noncleaved cell 01 01.5% NHLnon-Hodgkin s lymphoma 326 - - - Korean J Otolaryngol 2003;46:324-30
태경외 Table 6. Comparison of complete response according to patient characteristics in NHL Characteristics No. of patients No. of complete response % Total 68 45 66.2% Age 60 36 23 63.9% 60 32 22 68.8% Sex Male 38 23 60.5% Female 30 22 73.3% Histologic grade Low 11 08 72.7% Intermediate & high 57 37 64.9% Stage* & 42 31 73.8% & 26 14 53.8% B symptom No 48 33 68.8% Yes 20 12 60.0% LDH level Normal 26 20 76.9% High 42 25 59.5% Performance status ECOG* 01 43 32 74.4% 24 25 13 52.0% Therapy Chemotherapy 52 34 65.4% Combined therapy 16 11 68.8% 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 16 10075.0% Age 60 10 08 080.0% 60 06 04 066.7% Sex Male 12 09 075.0% Female 04 03 075.0% Histologic grade Lymphocyte predominant 01 00 000% Nodular sclerosis 06 04 066.7% Mixed cellularity 07 07 100.0% Lymphocyte depletion 02 01 050.0% Stage* & 09 09 100.0% & 07 03 042.8% B symptom No 08 07 087.5% Yes 08 05 062.5% LDH level Normal 12 09 075.0% High 04 03 075.0% Performance status ECOG 01 13 10 076.9% 24 03 02 066.7% Therapy Chemotherapy 11 06 072.7% Combined therapy 05 04 080.0% p0.05, HDHodgkin s disease 327
(Survival rate) Table 8. Univariate analysis of prognostic factors influencing overall survival rate in patients with NHL 328 1.0 1.9 1.8 1.7 1.6 1.5 1.4 1.3 1.2 1.1 0.0 (p>0.05) Factors overall survival rate % p-value Stage 0.004 74.6% 39.3% Serum LDH 0.01 Normal 80.3% Abnormal 49.5% Histologic grade 0.02 Low 100% Intermediate & high 54.8% ECOG performance 0.029 01 71.2% 24 44.7% NHLnon-Hodgkin s lymphoma HD (83.3%) NHL (62.2%) 0 10 20 30 40 50 60 70 (Months) Fig. 2. Overall survival of malignant lymphoma. Group HD NHL Korean J Otolaryngol 2003;46:324-30
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 0.04 1 3.18 1.357.48 Serum LDH 0.016 Normal 1 Abnormal 3.82 1.2811.39 Histologic grade 0.97 Low 1 Intermediate & high 2.17 0.603.53 ECOG performance 0.046 01 1 24 2.36 1.025.48 NHLnon-Hodgkin s lymphoma, CIconfidence interval 329
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