Clinical characteristics and prognostic analysis of 195 primary gastrointestinal diffuse large B-cell lymphoma

Abstract

Objective To explore the clinicopathological features and prognostic factors in patients with primary gastrointestinal diffuse large B cell lymphoma (PGI-DLBCL). Methods From January 2007 to January 2014, 195 patients with PGI-DLBCL in initial treatment were enrolled and clinical data of them were collected. Clinicopathological features, overall survival situation and the effects of therapeutic strategy on prognosis were retrospectively analyzed. Kaplan-Meier method was performed for survival analysis. Log-rank test was used for univariate analysis and the Cox proportional hazard regression model was used in multivariate factor analysis. Results Among 195 patients with PGI-DLBCL (117 male and 78 female patients, median age, 55 years), the tumors of 123 patients (63.1%) were located in stomach, 64 cases were in intestinal tract (32.8%, 24 cases in small intestine, 19 cases in ileocecum and 21 cases in colorectum) and eight cases (4.1%) had multiple gastrointestinal tract involvement. The one-year, three-year and five-year overall survival (OS) rates of 184 cases with complete follow-up data were 81.7%, 66.2% and 61.0%, respectively. The results of univariate analysis revealed that the prognostical factors affecting OS period included age, Eastern Cooperative Oncology Group performance status (ECOG PS), lesion location, large mass lesion, Lugano staging system, international prognostic index (IPI) score, the lactate dehydrogenase, β2-microglobulin, peripheral blood absolute lymphocyte/monocyte ratio (ALC/AMC) and serum albumin levels. The multivariate analysis by Cox proportional hazard regression model indicated that multiple gastrointestinal tract involvement (relative risk (RR)=1.378, 95% confidence interval (CI)1.144 to 1.661, P=0.001), end-stage by Lugano staging (RR=3.731, 95%CI 1.657 to 8.398, P=0.001) and ALC/AMC<2.6 (RR=1.816, 95%CI 1.055 to 3.127, P=0.031) were the independent adverse prognosis risk factors. The five-year accumulate OS rates of surgery group and non-surgery group were 65.0% and 53.3%, respectively, and the difference was not statistically significant (χ2=2.159, P=0.142). The five-year accumulate OS rates of combined with and without radiotherapy group were 77.5% and 58.0%, respectively, and the difference was not statistically significant (χ2=3.667, P=0.056). The five-year accumulate OS rates of combined with and without rituximab treatment group were 62.4% and 58.6%, respectively, and the difference was not statistically significant (χ2=1.352, P=0.243). Conclusions The prognosis is poor in PGI-DLBCL patients with multiple gastrointestinal tract involvement, later stage of Lugano staging and lower ALC/AMC. Neither surgery nor radiotherapy could improve OS of patients with PGI-DLBCL. Key words: Gastrointestinal tract; Lymphoma, large B-cell, diffuse; Clinical features; Prognosis