原發肺臟與唾液腺之黏膜相關淋巴組織淋巴瘤的生物學與治療對策研究

Abstract

中文摘要 研究目的 黏膜相關淋巴組織淋巴瘤是個少見的惡性腫瘤，雖然對於胃部黏膜相關淋巴組織淋巴瘤的發生與治療有越來越多的報告，但是在非胃部黏膜相關淋巴組織淋巴瘤的臨床表現、治療方式以及長期的病人存活，目前所知不多。 研究方法 本研究回顧性收集肺臟與唾液腺的黏膜相關淋巴組織淋巴瘤病人之臨床資料，病人臨床資訊收集時間從西元1993年到2014年止。為了更加了解黏膜相關淋巴組織淋巴瘤的特性，在本研究中也收集肺臟瀰漫性大B細胞淋巴瘤作為對照組。 研究結果 1. 肺臟黏膜相關淋巴組織淋巴瘤與肺臟瀰漫性大B細胞淋巴瘤的臨床比較 共有32位肺臟黏膜相關淋巴組織淋巴瘤病人以及17位肺臟瀰漫性大B細胞淋巴瘤病人，在五年無惡化存活期以及疾病整體存活，肺臟黏膜相關淋巴組織淋巴瘤都相對於瀰漫性大B細胞淋巴瘤族群來的比較好(p=0.004 以及p=0.045)。此外在肺臟黏膜相關淋巴組織淋巴瘤族群中，以治療方式做治療族群區分，接受手術治療者相比於沒有手術治療者，在無疾病存活似乎有傾向來的比較好，但統計學上沒有達到意義(p=0.176)。 2. 唾液腺黏膜相關淋巴組織淋巴瘤 共有14位唾液腺黏膜相關淋巴組織淋巴瘤的病人可以納入分析。治療方式與疾病臨床分期有高度相關，Ann-Arbor分期IE共有7位病人，其中有六位病人接受腮腺切除術，一位病人接受放射治療；有七位病人的分期是IIE、IIIE或是IVE，這些病人治療方式因為已經有淋巴結轉移，主要以化學治療為主。僅有一位病人因淋巴瘤惡化之故死亡，若以治療做區分，手術治療的病人似乎比化學治療的病人來的容易復發(p=0.241)，雖然人數過少而達不到統計學上的意義。 研究結論 肺臟與唾液腺黏膜相關淋巴組織淋巴瘤的長期存活很好，雖然最佳的治療方式尚未證實，但從本回顧性研究發現，局部手術治療在肺臟黏膜相關淋巴組織淋巴瘤是個不錯的選擇，但在唾液腺黏膜相關淋巴組織淋巴瘤族群，似乎復發率偏高。

Purpose Mucosa associated lymphoid tissue (MALT) lymphoma is a rare disease. Although more and more information of gastric MALT lymphoma is known, the clinical characteristics, treatment modalities, and outcomes of non-gastric MALT lymphoma are not well elucidated. Methods A retrospective review study of primary pulmonary and salivary gland MALT lymphoma cases at a single institution from 1993 to 2014 was conducted. For better comparison, a more aggressive lymphoma type, diffuse large B cell lymphoma, of primary lung origin was included into this study. Results 1. Pulmonary mucosa associated lymphoid tissue lymphoma We successfully collected clinical data of pulmonary MALT lymphoma. In addition, the data of pulmonary diffuse large B cell lymphoma (DLBCL) were collected as comparison. Thirty-two pulmonary MALT lymphoma patients and seventeen pulmonary DLBCL patients are included in this study. The 5-year event free survival and overall survival are better in MALT lymphoma group (p=0.004 and p=0.045) compared with DLBCL group. We also compared overall survival by different treatment modalities in MALT lymphoma group. Patients treated with surgery had a trend of better survival compared with other non-surgery(p=0.176). 2. Salivary gland mucosa associated lymphoid tissue lymphoma Clinical data of parotid MALT lymphoma was collected. Fourteen patients are included into this study. Treatment modalities were stratified by Ann-Arbor stage. Seven stage IE patients were treated with parotidectomy or curative radiation therapy. Seven patients with stage IIE, IIIE or IVE were treated with chemotherapy with or without Rituximab. Thirteen patients are alive till the end of follow-up. Only one patient died of progression of lymphoma. However, a trend of easy relapse in stage IE parotid lymphoma treated with parotidectomy(p=0.241). Conclusions MALT lymphoma of pulmonary and salivary gland origin has long overall survival compared with other types of lymphoma of the same origin. Although local surgery is an effective treatment for pulmonary and salivary gland MALToma, easy relapse is found in salivary gland MALToma. More studies are needed to elucidate this phenomenon.