Mehmet Önder EKMEN, Sinan DAL, Abdullah KARAKUŞ, Hüseyin BÜYÜKBAYRAM, Mehmet Orhan AYYILDIZ

Güneydoğu Anadolu Bölgesindeki Non-Hodgkin Lenfoma Sınıflaması: 550 Hastanın İncelenmesi

Amaç: Hodgkin olmayan lenfoma (NHL) alt tiplerinin dağılması tüm dünyada farklılık gösterir. Bu çalışmada, Ocak 2005- Aralık 2014 tarihleri arasında hastanemize başvuran NHL hastalarında cinsiyet, yaş, alt tipler, biyopsi alanları, nodal ve ekstranodal yerleşim alanı ve hastalığın evrelerini değerlendirmeyi amaçladık. Materyal ve Metod: Ocak 2005- Aralık 2014 tarihleri arasında hastanemize başvuran NHL hastalarının dosyaları retrospektif olarak tarandı. Bulgular: 550 hastanın 335'i (%60,9) erkek, 215'i (%39,1) kadındı. Tüm hastaların üzerinde yaş ortalaması 56 idi (15-95). Kadınların yaş ortalaması 57 (15-88), erkeklerin yaş ortalaması 54 (15-95) idi. NHL hastalarının histolojik alt tipleri şu şekildedir: 447 hasta (%81,3) B hücreli lenfoma, 84 hasta (%15,2) T / NK hücre lenfoması, 19 hasta (% 3.5) sınıflandırılmamış alt tip. NHL hastaları 2001 ve 2008 WHO (Dünya Sağlık Örgütü) Sınıflandırmasına ve histopatolojik alt tiplerine göre alt tiplere ayrıldı: Diffüz Büyük B Hücreli Lenfoma (DLBCL) 295 hasta (% 53,63), küçük lenfositik lenfoma (SLL) 37 hasta ( % 6.7), Ekstranodal marjinal bölge lenfoması (MALT tipi) 37 hasta (% 6,75), periferik T hücreli Lenfoma 27 hasta (% 4,9), manto hücreli lenfoma 26 hasta (% 4,72), Nodal Marjinal Bölge B-Hücre Lenfoması 7 hasta (% 1,3), 12 hastada foliküler lenfoma (% 2,1), Burkitt lenfoma 7 hasta (% 1,3), Splenik marjinal bölge B hücreli lenfoma 4 hasta (0,7). NHL'nin en sık görülen alt tipi DLBCL 295 hastasıydı (%53,63). Foliküler lenfomalar merkezimizde daha az görülür. Ekstranodal invlolvement oranı hastaların%38,5'i idi. Ekstranodal NHL'lerin bölgelerinin dağılımına göre, hastaların%43'ünde GI kanal tutulumu vardı. En sık etkilenen GI bölgeleri mide idi (%27,8). Bu çalışmada, hastaların %22,9'u Evre 1, Evre 2'de%26,7, Evre 3'te%19,5, Ann-Arbor sınıflandırmasına göre Evre 4'te%30,9 idi. Sonuç: NHL hastalarının özellikleri coğrafi farklılıklara göre değişmektedir. Bu çalışma geriatrik değerlendirmenin önemini ortaya koydu. NHL erkeklerde daha sık gözlendi. Çevresel risk faktörleri epidemiyolojik olarak araştırılmalıdır. NHL'nin en yaygın alt tipi DLBL'dir. Foliküler lenfomalar merkezimizde daha az görülür. Ulusal kanser kayıt sisteminin iyileştirilmesi ve NHL'nin erken tanı ve tedavisini sağlamak için tedavi protokollerini gözden geçiren çok merkezli büyük ölçekli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Non-Hodgkin Lenfoma epidemiyoloji, Histolojik alttipleri

Classification of Non-Hodgkin Lymphoma in Southeast Turkey: A Review of 550 Cases

Background: The distribution of non-Hodgkin lymphoma (NHL) subtypes differs around the world. In this study we aimed to evaluate the gender, age, subtypes, biopsy sites, nodal and extranodal residential area, and stage of disease in the patients with NHL admitted to our hospital between January 2005 and December 2014.Materials and Methods: The records of NHL patients admitted to our hospital between January 2005 and December 2014 were retrospectively reviewed Results: Among 550 patients, 335 patients (60.9%) were male, 215 patients (39.1%) were female. The average age of over all the patients was 56 years (15-95). The average age of women was 57 (15-88), the average age of men was 54 years (15-95). The histological subtypes of NHL patients were as follows: 447 patients (81.3%) B-cell lymphoma, 84 patients (15.2%) T / NK cell lymphoma, 19 patients (3.5%) unclassified subtype. NHL patients divided into subtypes according to 2001 and 2008 WHO (World Health Organization) Classification and histopathologic subtypes were as follow: Diffuse Large B Cell Lymphoma (DLBCL) 295 patients (53,63%), small lymphocytic lymphoma (SLL) 37 patients (6.7%), Extranodal marginal zone lymphoma (MALT type) 37 patients (6,75%), peripheral T-cell Lymphoma 27 patients (4.9%), mantle cell lymphoma 26 patients (4.72%), Nodal Marginal Zone B-Cell Lymphoma 7 patients (1,3%), follicular lymphoma in 12 patients (2.1%), Burkitt's lymphoma 7 patients (1.3%), Splenic marginal zone B-cell lymphoma 4 patients (0,7). The most common subtype of NHL was DLBCL 295 patients (53,63%). Follicular lymphomas are less common in our center. Extranodal involvement rate was 38,5% of patients. According to the distribution of the sites of extranodal NHLs, the vast majority of patients 43% had GI tract involvement. The most commonly affected GI sites were stomach (27,8%). In this study 22.9% of the patients were in Stage 1, 26.7% in Stage 2, 19.5% in Stage 3, 30.9% in Stage 4 according to Ann- Arbor classification. In conclusion, the characteristics of NHLs in our region show some differences from other sites of the world. Conclusions: The characteristics of NHL patients vary according to geographical differences. Present study has revealed the importance of geriatric assessment. NHL was observed frequently in men. Environmental risk factors have to research, epidemiologically. The most common subtype of NHL was DLBL. Follicular lymphomas are less common in our center. Improvement of national cancer registration system and multicenter large-scale studies reviewing the treatment protocols are needed to ensure the early diagnosis and therapy of NHL.

Keywords:

Non-Hodgkin’s lymphoma; epidemiology, histologic subtype,

PDF

___

References1- Jaffe ES, Harris. N.L., Stein H, Vardiman JW. WHO classification of tumours. Pathology and genetics of tumours of haematopoietic and lymphoid tissues Lyon: IARC; 2001..
2-Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015;65:5-29.
3-Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al (Eds). WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. International Agency for Research on Cancer: Lyon, France, 2008.
4-Anderson JR, Armitage JO, Weisenburger DD. Epidemiology of the non-Hodgkin’s lymphomas: distributions of the major subtypes differ by geographic locations. Non-Hodgkin’s Lymphoma Classification Project Ann Oncol 1998; 9(7): 717–720.
5-Laurini J, Perry A, Boilesen E, Diebold J, MacLennan K, Muller- Hermelink H, et al. Classification of non-Hodgkin lymphoma in Central and South America: a review of 1028 cases. Blood 2012; 120(24): 4795–4801.
6-Devesa SS, Silverman DT, Young JL Jr, Pollack ES, Brown CC, Horm JW, et al. Cancer incidence and mortality trends among whites in the United States, 1947–84. J Natl Cancer Inst 1987;79:701–70.
7-Howe HL, Wingo PA, Thun MJ, Ries LA, Rosenberg HM, Feigal EG, et al. Annual report to the nation on the status of cancer (1973 through 1998), featuring cancers with recent increasing trends. J Natl Cancer Inst 2001;93:824–42.
8-Hartge P, Devesa SS. Quantification of the impact of known risk factors on time trends in non-Hodgkin's lymphoma incidence. Cancer Res 1992;52(19 Suppl):5566s–9s
9- Shiels MS, Engels EA, Linet MS, Clarke CA, Li J, Hall HI, Hartge P, Morton LMCancer Epidemiol Biomarkers Prev June 2013 22; 1069. The Epidemic of Non–Hodgkin Lymphoma in the United States: Disentangling the Effect of HIV, 1992–2009
10- Jaffe ES, Harris. N.L., Stein H, Vardiman JW. WHO classification of tumours. Pathology and genetics of tumours of haematopoietic and lymphoid tissues Lyon: IARC; 2001.
11- Smith A, Crouch S, Howell D, Burton C, Patmore R, Roman E.Cancer Epidemiol. 2015 Sep 2. pii: S1877-7821(15)00179-4. doi: 10.1016/j.canep.2015.08.015
12- Haddadin WJ . Malignant lymphoma in Jordan:a retrospective analysis of 347 cases according to the World Health Organization classification. Ann Saudi Med 2005; 25: 398– 403.
13- Abdel-Fattah MM , Yassine OG . Non-Hodgkin ’ s lymphomas in Alexandria, Egypt; incidence rates and trend study (1995 – 2004) . Eur J Cancer Prev 2007 ; 16 : 479 – 485 .
14- Boudjerra N1, Perry AM, Audouin J, Diebold J, Nathwani BN, MacLennan KA, Müller-Hermelink HK, Bast M, Boilesen E, Armitage JO, Weisenburger DD.Classification of non-Hodgkin lymphoma in Algeria according to the World Health Organization classification.Leuk Lymphoma. 2015 Apr;56(4):965-70. doi: 10.3109/10428194.2014.939967. Epub 2014 Aug 20
15- Fetica B, Achimas-Cadariu P, Pop B, Dima D, Petrov L, Perry AM et al.. Non-Hodgkin lymphoma in Romania: a single-centre experience. Hematol Oncol. 2015 Oct 20. doi:10.1002/hon.2266. [Epub ahead of print]
16- Isikdogan A, Ayyildiz O, Buyukcelik A, Arslan A, Tiftik N, Buyukbayram H, et al. Non-Hodgkin’s lymphoma in southeast Turkey: clinicopathologic features of 490 cases. Ann Hematol 2004; 83(5): 265–9.
17-McDuffie HH1, Pahwa P, McLaughlin JR, Spinelli JJ, Fincham S, Dosman JA, Robson D, Skinnider LF, Choi NW. Non-Hodgkin's lymphoma and specific pesticide exposures in men: cross-Canada study of pesticides and health Cancer Epidemiol Biomarkers Prev. 2001 Nov;10(11):1155-63
18- Neasham D1, Sifi A, Nielsen KR, Overvad K, Raaschou-Nielsen O, Tjønneland A, Barricarte A et al. Occupation and risk of lymphoma: a multicentre prospective cohort study (EPIC). Occup Environ Med. 2011 Jan;68(1):77-81. doi: 10.1136/oem.2009.048173. Epub 2010 Sep 30.
19- Ramis R, Diggle P, Boldo E, Garcia-Perez J, Fernandez-Navarro P, Lopez-Abente G. Analysis of matched geographical areas to study potential links between environmental exposure to oil refineries and non-Hodgkin lymphoma mortality in Spain. Int J Health Geogr. 2012 Feb 6;11:4.
20- Dotlic S, Perry AM, Petrusevska G, Fetica B, Diebold J, MacLennan KA et al. Classification of non-Hodgkin lymphoma in South-eastern Europe: review of 632 cases from the international non-Hodgkin lymphoma classification project. Br J Haematol. 2015 Nov;171(3):366-72.
21- Zucca E, Cavalli F (2000) Extranodal lymphomas. Ann Oncol 11 [Suppl 3]:219–222
22- Di Leonardo G, Ginaldi L, De Martinis M, Stati M, Quaglino D (2000) Extranodal localizations of lymphoma. Clinico-epidemiologic study of 353 cases (abstract) (in Italian). Recenti Prog Med 91:500–506
23- Grogan TM, Jaramillo MA, Miller TP (2001) Natural history, diagnosis, and staging of the non-Hodgkin’s lymphomas. In:Haskell CM (ed) Cancer treatment. Philadelphia, WB Saunders, pp 1338–1375
24- Zucca E, Roggero E, Bertoni F, Cavalli F (1997) Primary extranodal non-Hodgkin’s lymphomas. Part 1: gastrointestinal, cutaneous and genitourinary lymphomas. Ann Oncol 8:727–737
25 -A. Ünal, B. Eser, M. Çetin, M. Altınbaş, E. Karahacıoğlu, O. Kontaş, B. Kaplan, Ö. Er ve H. Ş.Coşkun, “Clinico-pathologic characteristics of non-Hodgkin’s lymphoma patients at single center in Central Anatolia,” 25th European Society for Medical Oncology Congress, 13-17 October 2000, Hamburg Germany. Annals of Oncology, 11(Suppl 4), 102, 2000.
26- Arican A, Dincol D, Akbulut H, Onur H, Demirkazik A, Cay F, et al. (1999) Clinicopathologic features and prognostic factors of primary extranodal non-Hodgkin’s lymphomas in Turkey. Am J Clin Oncol 22:587–592
27- Paydas S, Kekec Y, Zorludemir S (1996) Gastro-intestinal lymphoma in southern Turkey. Cent Afr J Med 42:56–60
28- Yaqo RT , Hughson MD , Sulayvani FK , et al . Malignant lymphoma in northern Iraq: a retrospective analysis of 270 cases according to the World Health Organization classification. Indian J Cancer 2011 ; 48 : 446 – 451 .
29- Mozaheb Z , Aledavood A , Farzad F . Distributions of major subtypes of lymphoid malignancies among adults in Mashhad, Iran . Cancer Epidemiol 2011 ; 35 : 26 – 29 .
30- Liu J, Song B, Fan T, Huang C, Xie C, Li J, Zhong W, Li S, Yu J. Pathological and clinical characteristics of 1,248 non-Hodgkin's lymphomas from a regional cancer hospital in Shandong, China. Asian Pac J Cancer Prev. 2011;12(11):3055-61.
31- Akhtar S S, Haque I U, Wafa S M, e t a l. Malignant lymphoma in Al-Qassim, Saudi Arabia, reclassified according to the WHO classification. Saudi Med J 2009; 30: 677– 681.
32- Castella A , Joshi S , Raaschou T , et al . Pattern of malignant lymphoma in the United Arab Emirates–a histopathologic and immunologic study in 208 native patients . Acta Oncol 2001; 40: 660– 664.
33- Ameen R, Sajnani KP, Albassami A, et al . Frequencies of non-Hodgkin ’s lymphoma subtypes in Kuwait: comparisons between different ethnic groups. Ann Hematol 2010; 89: 179– 184.