Study Expands Knowledge of Prognostic Markers in Extranodal NHL

Extranodal NHL is not uncommon, comprising over 30% of NHL cases | image credit: Prostock Studio - stock.adobe.com

A myriad of characteristics correlate with worse outcomes for patients with non-Hodgkin lymphoma (NHL): lower levels of hemoglobin, higher levels of lactate dehydrogenase (LDH), ß2-microglobulin, higher Eastern Cooperative Oncology Group (ECOG) score, the presence of B symptoms, and stage III/IV disease status. NHL accounts for around 90% of all lymphoma cases, and new findings recently published in Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology helped shed light on what impacts individual risk and prognosis.1

One’s predisposition to NHL is greatly influenced by family medical history and the prevalence of certain immune disorders, neoplasms, viral and bacterial infections, and prior exposure to toxic materials.

With this in mind, the authors pointed to the insufficient research conducted for NHL of the neck and head areas despite extranodal cases making up 35% of NHL diagnoses. They stated how studies on NHL in these regions tend to concentrate on pathological and clinical features and pay little attention to the factors that affect prognosis and survival.

Over the last 10 years, incidence of extranodal NHL has increased and, despite the prognostic benefits afforded to patients by radiation and chemotherapies, extranodal disease in these cases typically has distinctive pathologies, cellular origins and clinical expressions. These differential qualities stress the need for more comprehensive understandings of patient outcomes with extranodal NHL and more dedicated research efforts to provide clearer guidance depending on the anatomical site of disease.2

The authors retrospectively reviewed data from an electronic health records platform (IANUS) between January 2005 and January 2016, stemming from a patient population with primary extranodal NHL (PE-NHL) in northwestern Spain. The researchers carefully examined these data to ensure that the extranodal element remained at the forefront of included cases and adhered to the standards set by the 2008 World Health Organization Classification for Lymphoid Neoplasms.1

A total of 145 patients, nearly equally male (51%; n = 74) and female (49%; n = 71), were enrolled. Those included were aged just over 67 years on average. The majority (69.3%) of these individuals presented with localized disease (stage I or II), and the remaining (30.7%) exhibited more advanced NHL (stage III or IV). Less than 20% had been experiencing B symptoms—such as fever, night sweats, and weight loss—and around one-third had documented prior or current experience with conditions affiliated with NHL risk. Tumors most prominently resided in the tonsil area (25.5%), then the parotid (19.3%), followed by the Waldeyer’s Ring (14.5%).

Histopathological analysis revealed that the vast majority of these cases demonstrated a B-cell phenotype (91.8%), and less than 8% stemmed from natural killer (NK) or T cells. The main treatments administered for these cases was immunochemotherapy.

Three- and 5-year overall survival (OS) rates were 75% and 73% respectively. Increased levels of LDH (HR, 1.002; 95% CI, 1.001-1.003), reduced hemoglobin concentration (HR, 0.691; 95% CI, 0.578-0.828), and greater ECOG scores all had significant correlations with these outcomes (HR, 7.947; 95% 3.254-19.405) (P < .001), as well as the presence of more advanced disease (HR, 2.162; 95% CI, 1.143-4.089; P = .008) and B symptoms (HR, 2.156; 95% CI, 1.087-4.275; P = .028). The researchers identified increased LDH and ß2-microglobulin levels and advanced-staged disease as risk factors for clinical relapse. The 3- and 5-year progression-free survival rates were 71% and 68%, respectively.

While the authors recognize the potentially limitations of a retrospective study, they point to its multicenter design as one of the strengths that bolster their findings. They conclude by advocating for future research in this area, highlighting how “understanding these prognostic factors could facilitate the optimization of follow-up and therapy for this specific subset of NHL.”

References

1. Bello-Castro A, Mosquera-Orgueira A, Gude-Smpedro F, et al. Prognostic and survival factors in head and neck extra-nodal non-Hodgkin's lymphoma. Oral Surg Oral Med Oral Pathol Oral Radiol. 2025;139(2):201-210. doi:10.1016/j.oooo.2024.09.007

2. Yang H, Xun Y, Ke C, Tateishi K, You H. Extranodal lymphoma: pathogenesis, diagnosis and treatment. Mol Biomed. 2023;4(1):29. doi:10.1186/s43556-023-00141-3