Upper aerodigestive tract lymphoma in Taiwan

Aim: To better understand the spectrum of primary lymphomas in the upper aerodigestive tract, a common site of extranodal lymphoma. Materials and 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.