- 學位論文
台灣地區眼窩及眼周淋巴癌之流行病學表現及預後預測因子
Demographic and prognostic factors of orbital and ocular adnexal lymphoma in Taiwan
摘要
目的: 比較台灣地區族群跟西方族群的眼窩及眼周淋巴癌之流行病學表現及預後預測因子。 方法: 以蒐集病歷資料的方式回溯過去從1985年01月到2019年12月在台大醫院就醫的眼窩及眼周淋巴癌病人資料。納入條件(Inclusion criteria)包括經過手術取樣組織病理診斷的眼窩及眼周淋巴癌，並且追蹤時間至少6個月以上。排除條件(Exclusion criteria)包括其他非淋巴癌的眼窩及眼周腫瘤以及發炎性疾病，像是甲狀腺眼疾或是第四型免疫球蛋白G相關的眼病變(IgG4-related ophthalmic disease)等等。人口統計訊息包括病歷所記載的年紀、性別、淋巴癌的次分類、腫瘤位置、腫瘤分期、治療方式都將進行統計分析。主要評估指標(primary endpoints)包括無疾病存活期(DSS)，整體存活期(OS)及疾病無惡化存活期(PFS)。 結果: 本次研究總共收錄了112位病人，平均發病的年齡為59.0 ± 15.5歲(範圍從23-92歲)，包括了59位男性(52.7%)及53位女性(47.3%)。大多數109位病人(97.3%)為B細胞淋巴癌，T細胞淋巴癌僅占3%。結節邊緣區型淋巴癌是其中最大宗，約76位病人(67.9%)，11人(9.8%)屬於瀰漫性大型B細胞淋巴癌、9人(8.0%)屬於濾泡性淋巴癌、6人(5.4%)屬於小淋巴球性淋巴癌、4人(3.6%)屬於被套細胞淋巴癌及其他種類。在腫瘤位置當中，最主要發生侵犯的位置為眼窩(44人，39.3%)，其次為結膜(31人，27.7%)，淚腺(27人，25%)，以及較少受到侵犯的眼瞼(8人，7.1%)。平均追蹤的期間為 89.5±72.3個月(範圍從6-342個月)，所有病人在5年及10年的無疾病存活期(DSS)分別為89.9%及81.6%; 在5年及10年的整體存活期(OS)分別為88.8%及78.0%; 在5年及10年的疾病無惡化存活期(PFS)分別為65.0%及56.2%。在預後預測因子分析的部分，病人年紀大於60歲、有高階較侵犯性淋巴癌、後期淋巴癌將有比較差之預後。 結論: 結節邊緣區型淋巴癌為在台灣地區最常見的眼窩及眼周淋巴癌種類，並且在台灣地區的比例也比西方國家要來的高。在比較年輕的病人(年紀<60歲)，較早期的眼周及眼窩淋巴癌(stage I and stage II)，及較低階的病理組織分類(結節邊緣區型淋巴癌(EMZL)、濾泡性淋巴癌(FL)、小淋巴球性淋巴癌(SLL))，病人的疾病相關生存期(DSS)預後較好。
並列摘要
Purpose: To evaluate the clinicopathological features of OALs between Taiwanese patients and Western population and the prognostic factors for survival outcome for OALs in Taiwanese cohort. Methods: A retrospective observational study with chart review for patient with ocular adnexal lymphoma (OAL) since January 1, 1985 to December 31, 2019 in National Taiwan University. Inclusion criteria were included with ocular adnexal lymphoma with biopsy-proven histological verification and follow up period at least 6 months. We excluded other orbital tumor or inflammatory disease, such as thyroid eye disease or IgG4-related ophthalmic disease. Demographic information such as age, gender, lymphoma subtype, tumor location, staging and treatment modalities were recorded. The primary endpoints were disease-specific survival (DSS), overall survival (OS) and progression-free survival (PFS). Results: Total 112 patients with OALs were retrospectively reviewed. The mean patient age was 59.0 ± 15.5 years (range, 23–92 years) with male slightly predominant (53%). The most frequent subtype were extranodal marginal zone B-cell lymphoma (EMZL) (67.9%), followed by diffuse large B-cell lymphoma (DLBCL) (9.8%), follicular cell lymphoma (FL) (8.0%), and small lymphocytic lymphoma (SLL) (5.4%). The anatomical locations for OALs were the orbit (44 patients, 39.3%), the conjunctiva (31 patients, 27.7%), the lacrimal gland (28 patients, 25.0%), and the eyelid (8 patients, 7.1%). With a mean follow-up time of 89.45±72.03 months (range 6-342 months), the DSS for all patients were 89.9%, 81.6% at 5 years and 10 years’ follow-up, respectively. The OS at 5 years and 10 years’ follow-up were 88.8%, and 78.0%, respectively. The PFS at 5 years and 10 years’ follow-up were 86.2%, and 61.2%, respectively. Regarding the analysis of prognostic factors, patients with older age (>60 year-old), high grade lymphoma subtype and advanced stage exhibited a worse prognosis. Conclusion: MALT type lymphoma constitutes most of OALs in Taiwan and occurs more frequently than in Western countries. Patients with younger ager, MALT lymphoma, FL, SLL and earlier stage have favorable outcomes compared with patients of older than 60 years-old, high grade lymphoma and Ann Arbor stage III-IV lymphoma.