Upper aerodigestive tract lymphoma in Taiwan.
OBJECTIVE
To better understand the spectrum of primary lymphomas in the upper aerodigestive tract, a common site of extranodal lymphoma.


METHODS
Lymphoma cases diagnosed at an institution in southern Taiwan from 1992 to 2007 were retrospectively studied with pathology and history review, immunohistochemistry, in situ hybridisation for Epstein-Barr virus (EBER-ISH), and statistical analysis.


RESULTS
70 patients were identified. The male to female ratio was 2:1, and the median age was 61.5 years (range 8-87); 73% of cases occurred in Waldeyer's ring or the oral cavity. Phenotypically, there were 45 (64%) B cell and 25 (36%) T cell or extranodal natural killer (NK)/T cell lymphoma (ENKL) including 42 (60%) diffuse large B cell lymphomas (DLBCLs), 22 (31%) ENKLs, three unspecified peripheral T cell lymphomas, two follicular lymphomas and one Burkitt lymphoma. EBER-ISH was positive in three (7%) of 42 DLBCLs and all 22 ENKLs. Most patients received chemotherapy with or without radiotherapy. The 5-year overall survival for all patients was 56.3% with B and T or NK/T cell lymphomas at 66.0% and 40.6%, respectively. Univariate analysis revealed that sinonasal presentation, T or NK/T cell phenotype, raised lactate dehydrogenase (LDH) activity, and Ann Arbor stage III/IV diseases were associated with prognostically significant higher hazard ratio (HR) of lymphoma-related death. However, only raised LDH remained significant on multivariate analysis. For DLBCLs, only raised LDH was prognostically significant on either univariate or multivariate analysis.


CONCLUSIONS
Only a limited number of lymphoma entities occurred primarily in this anatomical region. The 5-year overall survival rate was comparable to other reports, and raised LDH at diagnosis was the only significant prognostic factor identified. A relatively high incidence of EBV positivity was identified in DLBCLs in this anatomical region, and further studies are warranted to elucidate the clinicopathological significance of these tumours.
Chen
Shang-Wen
SW
Division of Hemato-Oncology, Department of Internal Medicine, Chi-Mei Medical Centre, Liouying, Tainan, Taiwan.
Chang
Sheng-Tsung
ST
Lu
Chin-Li
CL
Hwang
Wei-Shou
WS
Tsao
Chao-Jung
CJ
Huang
Wen-Tsung
WT
Chang
Kwang-Yu
KY
Chuang
Shih-Sung
SS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D002648:Child; D004812:Epidemiologic Methods; D020031:Epstein-Barr Virus Infections / Q000150:complications; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000628:therapy / Q000821:virology; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D016393:Lymphoma, B-Cell / Q000473:pathology / Q000628:therapy / Q000821:virology; D008228:Lymphoma, Non-Hodgkin / Q000473:pathology* / Q000628:therapy / Q000821:virology; D016399:Lymphoma, T-Cell / Q000473:pathology / Q000628:therapy / Q000821:virology; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000628:therapy / Q000821:virology; D009367:Neoplasm Staging; D011379:Prognosis; D055815:Young Adult
D014408:Biomarkers, Tumor; D007770:L-Lactate Dehydrogenase