Clinical Features And Prognosis Of Jaw Non-hodgkin’s Lymphoma

Background and ObjectsMalignant lymphoma is a kind of tumor originating from the lymphatic system.Pathologically,it can be divided into Hodgkin lymphoma(HL)and non-Hodgkin lymphoma(NHL).The maxillofacial and neck region is the second common site of extranodal NHL,but the incidence of NHL in the jaw is low,and the incidence of the mandible only accounts for 0.6%of all NHL patients.The most common pathological type of NHL of the jaw is diffuse large B-cell lymphoma(DLBCL).Clinically,patients often complain of local pain,numbness,mass formation or recurrent toothache and other non-specific symptoms.In addition,the lesions involved in the periodontal and the apical periodontium area are often accompanied by manifestations similar to odontogenic diseases,which often making misdiagnoses such as periapical inflammation,periodontal abscess or osteomyelitis.For the treatment of this disease,lymphoma patients are sensitive to chemotherapy and radiotherapy.CHOP and R-CHOP are often used as first-line chemotherapy regimens and combined with radiotherapy for treatment.Surgeries are not used as conventional treatment methods,but only used as a tool of obtaining biopsy tissues or treatment of pathological fractures.In our study,the clinical data of 24 patients admitted to the First Affiliated Hospital of Zhengzhou University and diagnosed as non-hodgkin’s lymphoma of jaw bone from January 2014 to January 2020,were studied retrospectively.We summarized the disease clinical characteristics,and analyze the clinical factors that may be associated with the prognosis of the disease.MethodsThe clinical data of 24 patients admitted to the First Affiliated Hospital of Zhengzhou University and diagnosed as non-hodgkin’s lymphoma of jaw from January 2014 to January 2020,were studied retrospectively.We summarized the disease clinical characteristics,and analyze the clinical factors that may be associated with prognosis.The research object including general clinical data(age,gender,sites,chief complaint,IPI score and Ann Arbor staging),inspection index(WBC,neutrophil,blood platelet,hemoglobin,C-reactive protein,serum lactate dehydrogenase,blood uric acid,β-2 microglobulin,D-dimer,etc.),imaging,pathological classification,immunohistochemical results(CD10,BCL-6,BCL-2,Ki-67,MUM1),c-myc Bcl-2 Bcl-6 immunofluorescence test results,treatment and efficacy,survival time and survival status.Statistical analysis:The SPSS20.0 was used for statistical analysis of the data,Kaplan-Meier was used to do survival curve and univariate analysis.Significant prognostic indicators acquired from univariate analysis were included in Cox model for multivariate analysis.The difference was considered statistically significant,when P<0.05.Results1.Among the 24 patients,there were 21males(87.50%)and 3 females(12.50%);The median age of onset was 56 years.11 cases involved in the upper jaw(45.82%),while 13 cases involved in lower jaw(54.17%).12 cases(50.00%)complained of local painless mass,4 cases(16.67%)of ulceration or abscess formation of oral mucosa,3 cases(12.50%)of toothache,3 cases(12.50%)of abnormal sensation in the mouth,cheek or chin,and 2 cases(8.33%)of others.IPI score:0-1:12 cases(50.00%),2:5 cases(20.83%),3:5 cases(20.83%),4-5:2 cases(8.33%).Ann Arbor stages:Ⅰ-Ⅱ period 13 cases(54.17%),Ⅲ-Ⅳ period 11 cases(45.82%).2.Imaging findings:bone destruction could be divided into osteolytic type(12 cases),hardening type(3 cases),mixed type(5 cases),and imaging findings were generally normal type(4 cases).Soft tissue mass was found in 19 cases.2 cases with periosteum reaction;The lesion involved the tooth in 8 cases.No obvious dilation and destruction of mandibular neural tube and mental foramen were observed.3.Pathological classification:diffuse large B-cell lymphoma in 15 cases(62.50%),Burkitt lymphoma in 3 cases(12.50%),NK/T cell lymphoma in 3 cases(12.50%),marginal zone lymphoma in 1 case(4.17%),plasma cell lymphoma in,1 case(4.17%),and B-lymphoblastic lymphoma in 1 case(4.17%).4.Evaluation of treatment and efficacy:5 patients received CHOP chemotherapy,6 patients received R-CHOP chemotherapy,2 patients received EPOCH chemotherapy,2 patients received radiotherapy,3 patients received R-CHOP combined with radiotherapy,2 patients received surgery,and 4 patients received other regiments.After 4 cycles of chemotherapy,8 patients were evaluated as CR(8/24),5 patients were evaluated as PR(5/24),4 patients were evaluated as SD(4/24),and 7 patients were evaluated as PD(7/24).5.Survival analysis:the median survival time of the 24 patients was 34 months(95%CI,28.501-39.499),and 9 patients died.Three indicators,serum lactate dehydrogenase,IPI score,Ki-67 expression of patients,have prognostic significance to OS(P=0.029,P=0.001,P=0.018).These three factors were included in the Cox regression model,and the statistical values were P=0.439,P=0.013,and P=0.242,respectively.The rest of the indicators:gender,age,sites,Ann Arbor staging,WBC,neutrophil,blood platelet,hemoglobin,C-reactive protein,blood uric acid,②-2 microglobulin,D-dimer,CD 10,BCL-6,BCL-2,and MUM1 has no obvious statistical significance to OS.Conclusion1.The median age of non-Hodgkin’s lymphoma of the jaw was 56 years,mostly in men,and often occurs in the mandible.Patients often seek medical treatment with the finding of local masses as the chief complaint.2.The imaging manifestations of non-Hodgkin’s lymphoma of the jaw are osteolytic bone destruction accompanied by the formation of masses,occasionally periosteum reaction,and imaging changes such as widened periodontal membrane,disappearance of hard bone plates and disappearance of tooth embryo sac wall when involved in the periodontal site of the apical periodontium3.Elevated serum lactate dehydrogenase level,Ki-67 positive overexpression,and high IPI score may be associated with poor prognosis.IPI score may be an independent factor to effectively evaluate the prognosis of this disease.