Clinical relevance of three subtypes of primary sinonasal lymphoma characterized by immunophenotypic analysis.
BACKGROUND
The purpose of this study was to investigate the clinical relevance of subtypes categorized by immunophenotypic analysis in primary sinonasal lymphomas.


METHODS
Eighty patients with localized non-Hodgkin's lymphoma involving the nasal cavity and/or paranasal sinuses were divided into three subtypes on the basis of their immunohistochemical findings: (A) B-cell lymphoma (n = 19), (B) T-cell lymphoma (n = 27), and (C) natural killer (NK)/T-cell lymphoma (n = 34). The clinicopathologic profiles, immunophenotypic data, patterns of treatment failure, and survival data among the three patient groups were retrospectively compared.


RESULTS
The nasal cavity was the predominant site of involvement in T-cell and NK/T-cell lymphoma, whereas sinus involvement without nasal disease was common in B-cell lymphoma. Systemic B symptoms were frequently observed in NK/T-cell lymphoma. Almost all patients with NK/T-cell lymphoma showed a strong association with the Epstein-Barr virus by in situ hybridization studies. Sixty-five patients (81%) patients achieved complete remission after initial treatment, but 36 (55%) of these subsequently experienced treatment failure. Although there were no significant differences in locoregional failure rates among the patients of the three groups, distant failure was far more common in B-cell or NK/T-cell lymphoma than in T-cell lymphoma (p =.005). Most B-cell lymphoma cases showed a predilection for sites of systemic failure in the nodal and extranodal sites below the diaphragm, such as the paraaortic lymph nodes or the gastrointestinal (GI) tract, whereas patients with NK/T-cell lymphoma showed an increased risk of systemic dissemination to the skin, testes, or GI tract, including the development of hemophagocytic syndrome. The 5-year actuarial and disease-free survival rates for all patients were 57% and 51%, respectively. Of the three subtypes of primary sinonasal lymphomas, T-cell lymphoma seemed to carry the most favorable prognosis and NK/T-cell lymphoma the worst. (The 5-year actuarial survival rate was 57% for B-cell lymphoma, 80% for T-cell lymphoma, 37% for NK/T-cell lymphoma; p =.02, log-rank.) By univariate and multivariate analyses, immunophenotype was identified as the most important prognostic factor.


CONCLUSIONS
Our data indicate that the three subtypes of primary sinonasal lymphomas classified by immunohistochemical studies exhibit different clinical profiles, different patterns of failure, and different treatment outcomes. Given these observations, it is concluded that the recognition of these distinct subsets, diagnosed on the basis of immunophenotypic study, is very important and clinically relevant in predicting their potential behavior and prognosis.
Kim
Gwi Eon
GE
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University, College of Medicine, Brain Korea 21 Project for Medical Science, Seodaemoon-Gu, Shinchon-Dong 134, Seoul 120-752, Korea. gekim@yumc.yonsei.ac.kr
Koom
Woong Sub
WS
Yang
Woo-Ick
WI
Lee
Sang-Wook
SW
Keum
Ki Chang
KC
Lee
Chang Geol
CG
Suh
Chang Ok
CO
Hahn
Jee Sook
JS
Roh
Jae Kyung
JK
Kim
Joo Hang
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D018951:Antigens, CD20 / Q000378:metabolism; D019002:CD56 Antigen / Q000378:metabolism; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D007694:Killer Cells, Natural; D016393:Lymphoma, B-Cell / Q000145:classification / Q000378:metabolism* / Q000401:mortality / Q000628:therapy; D016399:Lymphoma, T-Cell / Q000145:classification / Q000378:metabolism* / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010255:Paranasal Sinus Neoplasms / Q000145:classification / Q000378:metabolism* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D017211:Treatment Failure
D018951:Antigens, CD20; D019002:CD56 Antigen