Analysis Of The Therapeutic Effect And Prognostic Factors Of Primary Waldeyer’s Ring Non-Hodgkin’s Lymphoma

Objective The primary waldeyer’s ring non-hodgkin’s lymphoma among patients with clinical characteristics,treatment and prognostic factors were researched.Meanwhile,the correlation of prognostic factors with overall survival and progression free survival was also compared.The results could provide the basis for prognosis stratification and individualized treatment for waldeyer’s ringnon-Hodgkin’s lymphoma.Methods A total of 107 patients was collected with primary waldeyer’s ring NHL,which was treated in general hospital of Ning Xia medical university from October 2011 to October2019.By the way,Clinical characteristics,treatment methods and prognostic factors were analyzed,and the correlation of prognostic factors with OS and PFS was compared.Furthermore,the ROC curve determines the cut-off values of the ratio of lymphocytes to monocytes(LMR)and the ratio of LMR to lactate dehydrogenase in 71 patients with diffuse large B-cell lymphoma before treatment.According to the cut-off values,groups were defined into high group and low group,which was depended on that high group with a value greater than the critical valueand low group with a value less than or equal to the critical value.The chisquare test was used to analyze the constituent ratio and rate of LMR high and low groups,LMR/LDH high and low groups.Kaplan Meier method was used to calculate survival rate.univariate analysis was tested by Log Rank method.Cox risk regression model was used to analyze multivariate analysis,P < 0.05 was statistically significant.Results 1.In this study,among 107 patients with primary Waldeyer’s ring NHL,the median age was 56 years old,the more patients are male,the early stage patients was more than late stage,the most common primary site was tonsil,and the most common histological subtype was DLBCL.The median follow-up time was 38 months(4-107 months).The 5-year OS and PFS of the whole group were 70.8% and 57.0%,respectively.2.The median follow-up time of 71 patients with primary waldeyer’s ring DLBCL was 45 months(5-107 months),the5-year OS and 5-year PFS were 74.2% and 58.7%.There were 50 patients with early stage(Ⅰ-Ⅱ),the 5-year OS and PFS were 85.9% and 74.0%,respectively.There were 21 patients with advanced stage(Ⅲ-Ⅳ),the 5-year OS and PFS were 47.6% and 23.8%,respectively.In early stage patients,the prognosis of chemoradiotherapy group was significantly better than chemotherapy group,the 5-year OS and PFS were 100% vs.74.5%(P= 0.024)and 87.7% vs.63.1%(P = 0.028),respectively.The patients achieved CR after initial treatment had a significant survival advantage compared with the chemotherapy group,but there was no significant difference.The patients not reach CR after initial chemotherapy had significant advantages in OS and PFS compared with chemoradiotherapy group and chemotherapy group(P=0.003,P=0.040).The 5-year OS and PFS of combined and uncombined rituximab groups were99.3% vs.74.4%(P=0.095)and 74.4% vs.70.7%(P=0.448),respectively.There was nostatistically significant.In the chemotherapy group,the combination of rituximab had a better prognosis,the 5-year OS and PFS were 88.3% vs.38.1%(P = 0.004)and 71.3% vs.38.1%(P = 0.037),respectively.In the rituximab era,the5-year OS and PFS of the combined and uncombined radiotherapy groups were 100%vs.88.3%(P=0.609)and 76.9%vs.71.3%(P=0.504),respectively.The survival curve of the two groups showed that chemoradiotherapy had certain advantages in improving the prognosis.3.According to the ROC curve,the cut-off values of LMR and LMR / LDH were 2.97 and 1.56,respectively.Low LMR group was more likely to occur in patients with advanced age,late clinical stage,higher IPI score and higher LDH than the upper limit of the normal.The low LMR/LDH group showed the same trend with LMR.The prognosis of patients in the high LMR group was significantly better than that in the low LMR group(P < 0.001).The prognosis of patients in the high LMR/LDH group was significantly better than that in the low LMR/LDH group(P < 0.001).4.Univariate analysis showed that the age,B symptoms,clinical stage,treatment efficacy,IPI score,LDH level,LMR and LMR/LDH were important factors that influenced the prognosis of waldeyer’s ring DLBCL.Multivariate analysis showed that the age,clinical stage and LMR/LDH were independent prognostic factors.Conclusion 1.Primary waldeyer’s ring NHL was more likely to occur in middle-aged people,mostly in male patients,with a large proportion of early patients and a lower tumor burden.The most common primary site was the tonsil,and the most common histological subtype was DLBCL.2.The prognosis of the chemoradiotherapy treatment group was significantly better than that of the chemotherapy group in the early waldeyer’s ring DLBCL patients.Radiotherapy was effective in patients who did not achieve CR after chemotherapy.3.Age,B symptoms,clinical stage,treatment efficacy,IPI score,LDH level,LMR and LMR/LDH were important factors affecting the prognosis of DLBCL in early waldeyer’s ring.Age,clinical stage and LMR/LDH were independent prognostic factors.4.LMR and LMR/LDH before treatment could have certain value in predicting the prognosis of DLBCL patients with waldeyer’s ring.