Non-Hodgkin's lymphomas involving Waldeyer's ring: a proposal for clinical categorization

The clinicopathologic data of 97 patients with non-Hodgkin's lymphomas involving Waldeyer's ring were retrospectively reviewed. Age, sex, the site of involvement within Waldeyer's ring, and Rappaport's histological classification played little role in the prognosis. Although the Ann Arbor staging classification was the only factor that correlated with the patients' prognoses (stage I vs stage II, p less than 0.01; stage II vs stage III + IV, p less than 0.02), it is not considered the ideal classification. The survival rates of stage II patients, who comprised about 60% of the entire group, was quite different due to their cervical node status. That is, 33 patients with bulky cervical nodes (4 cm in diameter or more) or bilateral cervical nodes had significantly poorer survival rates than 24 patients with small unilateral cervical nodes (p less than 0.001). The survival curve of the former group was similar to that of the stage III and IV patients, whereas the survival curve of the latter group was similar to that of the stage I patients. Lymphography, which was performed for 72 patients in this series, is not considered essential. From these results, we recommend the categorization of patients with malignant lymphomas involving Waldeyer's ring into two major groups according to cervical and inguinal node status in order to assess treatment methods. That is, patients with bulky or bilateral cervical lymph nodes or those with inguinal lymphadenopathy and patients without any lymphadenopathy or those with minimal unilateral cervical nodes alone.