Primary Gastrointestinal Lymphoma Research Articles

S2764 A Rare Case of Primary Gastrointestinal Mantle Cell Lymphoma Hiding in Plain Sight as Colon Polyps

S2764 A Rare Case of Primary Gastrointestinal Mantle Cell Lymphoma Hiding in Plain Sight as Colon Polyps

Primary appendiceal lymphoma managed through videolaparoscopic appendectomy in an Amazonian center: Case report and review of literature

Introduction: Primary gastrointestinal lymphoma is rare and appendix involvement is rarer. Most cases of appendiceal lymphoma present as clinical acute appendicitis and are generally diagnosed intra-operatory. Some computed tomography findings in preoperative evaluation may suggest appendix neoplasm rather than appendicitis, such as appendix diameter larger than 15 mm, abdominal lymphadenopathy and aneurysmal dilatation of the lumen. Case Report: We report a case of a 26-year-old Brazilian man first diagnosed with acute appendicitis and submitted to videolaparoscopic approach with appendectomy and posterior chemotherapy after histopathological reveal of primary appendiceal lymphoma. Conclusion: Surgical resection followed by chemotherapy remains as standard management choice when possible. Adequate investigation and mandatory histopathological analysis in appendectomies are fundamental for diagnosis and proper treatment.

Primary Gastrointestinal Lymphoma: Clinicopathological Study: 10 Years Experience in a Tertiary Care Center in Southern India

Background: The gastrointestinal tract (GIT) is a common site for extranodal lymphomas, accounting for 10%–15% of all non-Hodgkin lymphoma cases and 30%–40% of extranodal lymphomas. Regarding the incidence of the various histological subtypes and areas of involvement, there is a lot of heterogeneity in the literature. This study looked into the anatomical distribution, histological subtypes, and locations of primary gastrointestinal tract lymphomas (PGL) that were seen at a tertiary referral hospital in Southern India. Materials and Methods: A retrospective analysis of 96 individuals who had been diagnosed with PGL over the course of 10 years (2012–2022) was done. We carried out an audit of the clinicopathological profile of patients with PGL diagnosed over a period of 10 years. All lymphomas were classified according to the World Health Organization’s 2008 classification. Results: Of the 96 patients with PGL, 74 (77%) were male. The most common site for PGL was the stomach (50%), followed by the terminal ileum (14.58%). The most common histological subtype was diffuse large B cell lymphoma (DLBCL), which was seen in 85.42% of the patients. The most common symptom was abdominal pain (51.04%). Rituximab–cyclophosphamide–doxorubicin–vincristine–prednisolone was the most commonly used treatment regimen (56.3%). Conclusion: In this large single-center retrospective study, we found that the pattern of distribution of PGLs in India is comparable to the Western literature in that the stomach is the most prevalent site of PGL and DLBCL is the most common histological subtype.

Epidemiological features and prognosis for primary gastrointestinal follicular lymphoma.

Primary gastrointestinal follicular lymphoma (PGI-FL) is a rare extra-nodal lymphoma. Its epidemiology and prognosis remain unclear. We performed a retrospective analysis of eligible patients with 1648 PGI-FL and 34 892 nodal FL (N-FL) in the Surveillance, Epidemiology and End Results (SEER) database. The age-adjusted average annual incidence of PGI-FL was 0.111/100000. The median overall survival (OS) for PGI-FL and N-FL patients was 207 and 165 months respectively. The 5-year diffuse large B-cell lymphoma (DLBCL) transformation rates were 2.1% and 2.6% respectively. Age, sex, grade, Ann Arbor stage, primary site and radiation were independent prognostic factors (p < 0.05). Nomograms were constructed to predict 1-, 5- and 10-year OS and disease-specific survival (DSS). The receiver operating characteristic curves and calibration plots showed the established nomograms had robust and accurate performance. Patients were classified into three risk groups according to nomogram score. In conclusion, the incidence of PGI-FL has increased over the past 40 years, and PGI-FL has a better prognosis and a lower DLBCL transformation rate than N-FL. The nomograms were developed and validated as an individualized tool to predict survival. Patients were divided into three risk groups to assist clinicians in identifying high-risk patients and choosing the optimal individualized treatments.

Risk of Primary Gastrointestinal Lymphoma in Patients With Inflammatory Conditions Exposed to Tumor Necrosis Factor Alpha Inhibitors and Immunomodulators: A Case-Control Study.

The aim of this case-control study was to determine if exposure to tumor necrosis factor alpha inhibitors (TNFIs) or immunomodulators (thiopurines or methotrexate) was associated with development of primary gastrointestinal lymphoma (PGIL) in patients with chronic inflammatory conditions. Patients with PGIL and controls evaluated at a tertiary care center over 20 years were matched 1:3 using a medical record informatics search engine based on their chronic inflammatory condition (Crohn's disease [CD], ulcerative colitis [UC], rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis) and duration of follow-up. Patients who started on TNFI within 3 months of PGIL diagnosis were excluded. We extracted demographics, medical history, and medications used. Univariate models using conditional logistic regression were used due to the small number of matched pairs. Twenty PGIL cases matched with 60 controls were followed for a mean 9.9 ± 6.9 and 9.7 ± 8.6 years, respectively. Mean age at time of PGIL diagnosis was 47.5 ± 22.0 (standard deviation) years and the majority (75%) were males. The most common inflammatory diagnosis was inflammatory bowel disease (80% of cases; 45% with UC and 35% with CD). Development of PGIL was not associated with TNFI (odds ratio [OR] = 2.6; 95% confidence interval [CI] 0.69-11.01; P = .18), but with use of TNFI in combination with thiopurines (OR = 8.93; 95% CI 1.43-80.25; P = .014). Risk of PGIL increased with every additional TNFI (2.277 (1.002-5.713); P = .0494). All cases exposed to multiple TNFI were also exposed to thiopurines. Use of thiopurines (alone or in combination) was the greatest risk factor (OR = 6.32; 95% CI 1.55-37.05; P = 0.006) to develop PGIL. TNFI therapy was not associated with increased risk for PGIL unless used in combination with thiopurines and with every switch to a different TNFI.

Primary Intestinal T-cell Lymphomas – A Case Series from a Tertiary Center in South India

Abstract Background: Gastrointestinal tract (GIT) is the most common site for extranodal lymphomas, however, primary T-cell lymphomas of GIT are a rare occurrence. The aim of this study is to highlight the diverse clinical presentation and disease course of intestinal T-cell lymphomas, as per the 2019 World Health Organization classification of tumors of the digestive system. Materials and Methods: Out of 77 primary gastrointestinal lymphoma cases diagnosed over a 10-year period (2013–2023), there were five patients with primary intestinal T-cell lymphomas and their demographics, presentation, and clinical course were scrutinized. Results: The male-to-female ratio was 2:3 and the median age was 63.8 years. Involvement of the ileum and ileocecal region was seen in three patients, and jejunal and colonic involvement in one each. All patients presented with advanced stages of disease and progressed rapidly despite aggressive chemotherapy. Conclusion: Intestinal T-cell lymphomas are rare with diverse presentations and dismal prognoses despite the availability of chemotherapeutic regimens. It also reflects the need for pathologists to recognize the disease for appropriate patient management and prognostication. Collaborative studies will help to further characterize the disease for personalized treatment.

Primary gastrointestinal follicular lymphoma

Primary gastrointestinal follicular lymphoma

High IL-10 Expression Is Associated with Poor Prognosis in Primary Gastrointestinal Lymphoma

Background：Primary gastrointestinal lymphoma（PGIL）is defined as the primary malignant lymphoma of the gastrointestinal tract. The long-term prognosis and life quality of PGIL patients are influenced due to gastrointestinal complications. Cytokines have a close immunological relationship with lymphocytes, however, the relationship with serum cytokines and PGIL prognosis is still unknown. Method：We conducted a retrospective analysis of 165 PGIL patients referred to Department of Hematology of Peking university third hospital over a 10-year period between 2012-2022，and serum cytokine detection was performed on 85 patients' peripheral blood. Serum cytokine（IL-2,IL-4,IL-6,IL-9,IL-10,TNF-a）were quantified using flow cytometer. Median follow-up time was 29 months, and 1-year progression-free survival(PFS) of total PGIL patients was 84.1%, and 3-year PFS was 67.9%.The 1-year overall survival（OS）was 90.9%,and 3-year OS was 89.2%. Results：The median age of PGIL patients was 57-year-old, and 58.8% of them were male. The two most common pathological types were diffuse large B-Cell lymphoma (40.0%) and mucosa-associated lymphoid tissue(30.6%).Our results also showed that IL-4 level was higher in surviving PGIL patients, while IL-10 level was higher in deceased PGIL patients. There was no statistically significant difference in other serum cytokines(IL-2,IL-6,IL-9, TNF-a) between surviving and deceased PGIL patients. Survival analysis showed that the OS of patients in the low IL-10 level group was lower than that in the high IL-10 group（P=0.03） Conclusion：High IL-10 expression is associated with poor prognosis in primary gastrointestinal lymphoma

Clinical characteristics and prognostic factors for primary pediatric and adolescent Non-Hodgkin Lymphomas of the gastrointestinal tract: a population-based study

PurposeTo investigate the clinical features and survival outcomes of primary gastrointestinal non-Hodgkin lymphomas (PGINHL) in pediatric and adolescent population, we conducted a population-based cohort study.MethodsAll pediatric and adolescent patients with PGINHL diagnosed between 2000 and 2019 were identified using the Surveillance, Epidemiology, and End Results (SEER) database. Kaplane-Meier estimations were used to generate survival curves based on various criteria. To compare survival curves, the log-rank test was applied. A multivariate Cox proportional hazards model was developed to investigate the effect of each component on overall survival.ResultsA total of 334 pediatric and adolescent with PGINHL patients were identified. The median age at diagnosis was 12 years (range 1.0–19 years). Tumors were most commonly found in the small bowel (47.3%), followed by the large bowel (42.8%) and the stomach (9.9%). Overall, the most common histological subtype was Burkitt lymphoma (56.9%), followed by diffuse large B-cell lymphoma (DLBCL) (27.8%). Overall survival rates for all patients were 92.2% at 5- year and 91.6% at 10- year, respectively. The Cox proportional hazard regression revealed that only chemotherapy was an important independent predictor in this model. Patients with chemotherapy have a higher survival rate than those without.ConclusionsOur study revealed that only chemotherapy was found to be the most important predictor of the OS in pediatric and adolescent PGINHL, providing critical information for therapeutic care.

PET Radiomics Score Generated By Cross-Combination Approach for Treatment Response and Prognosis Prediction in Primary Gastrointestinal Diffuse Large B-Cell Lymphoma Patients

Background: Current risk stratification for primary gastrointestinal diffuse large B-cell lymphoma（PGI-DLBCL） relies on mainly on clinical factors. Radiomics score (RadScore) associated with survival outcomes have been developed for other cancer types, however few studies have thus far examined the role of radiomics in PGI-DLBCL. Objective: In this study, we investigated the value of PET RadScore constructed using a machine learning cross-combination approach in predicting the early treatment response and prognosis of patients with primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL) treated with the R-CHOP-like regimen. Methods: A retrospective analysis was conducted on 108 PGI-DLBCL patients diagnosed through histopathological examination at two independent medical centers from March 2011 to March 2023, with 86 patients in the training cohort and 22 patients in the validation cohort. Seven different machine learning models were used to generate 49 feature selection-classification candidates, and the optimal candidate was selected based on the area under curve of ROC to establish RadScore. Risk factors were identified through logistic regression, and a radiomics nomogram was constructed by combining RadScore with the selected risk factors. The model was evaluated through calibration curves and decision curve analysis (DCA) using the training cohort and validation cohort. Results：A total of 111 radiomics features were extracted, and 19 features with strong predictive performance were selected to generate RadScore. The results suggest that RadScore can stratify patient prognosis.The logistic regression analysis results in the training cohort showed that elevated lactate dehydrogenase (LDH) level (OR=3.53, 95%CI: 1.21-10.31, p=0.021), intestinal involvement (OR=3.04, 95%CI: 1.04-8.88, p=0.042), and total lesion glycolysis (TLG) (OR=6.73, 95%CI: 2.23-20.29, p＜0.001) were independent risk factors for predicting early treatment response. A multi-parameter model incorporating clinical risk factors, metabolic factors, and RadScore was constructed (training cohort AUC: 0.834; validation cohort AUC: 0.902), and the performance of the model was evaluated. Conclusion：The RadScore, constructed based on a cross-combination approach using machine learning, can predict the survival of PGI-DLBCL patients. When RadScore is combined with clinical risk factors and metabolic factors, it forms a combinatorial model suitable for predicting early treatment response to R-CHOP-like chemotherapy regimens. Larger studies will be needed to validate these results. Keywords ： Primary gastrointestinal diffuse large B-cell lymphoma · [18F]FDG PET/CT · Early treatment response · Prognosis · Machine learning

S2238 Primary Gastrointestinal Lymphoma Presenting as a Large Bowel Obstruction in a Young Patient

S2238 Primary Gastrointestinal Lymphoma Presenting as a Large Bowel Obstruction in a Young Patient

Endoscopic and Histopathological Characteristics of Gastrointestinal Lymphoma: A Multicentric Study.

Background: Extranodal non-Hodgkin lymphoma (NHL) is more prevalent in the gastrointestinal (GI) tract than in other sites. This study aimed to determine the endoscopic characteristics of primary gastrointestinal non-Hodgkin lymphomas. Methods: We investigated 140 patients from three tertiary referral hospitals with primary malignant lymphoma of the gastrointestinal tract. Characteristics of the lesions were evaluated and analyzed using image-enhanced endoscopy, endoscopic ultrasound, and histopathology. Results: The median age was 60.5 (range: 11-99), and 59 (42.1%) were female. The most frequent complaint was abdominal pain (74.3%), followed by bloody feces (10%) and diarrhea (2.9%). B symptoms were observed in 15 (10.7%) patients. GI obstruction was the most common complication (10.0%), followed by hemorrhage (7.9%) and perforation (1.5%). Regarding endoscopic findings, the identified sites were the following: the stomach (61.4%), colon (10%), small intestine (10%), ileocecum (8.6%), rectum (6.4%), and duodenum (3.6%). Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma are most prevalent in the stomach. Helicobacter pylori was identified in 46 cases (39.0%), with MALT lymphoma being the most infected subtype. Nearly all gastrointestinal non-Hodgkin lymphomas manifested as superficial type (25-59.6%) and ulcer type (15.6-50%) under endoscopy. We found that fungating type and protruding with ulcer type were more frequent types of aggressive lymphomas (diffuse large B-cell lymphoma, mantle cell lymphoma, and T-cell lymphoma) compared to the indolent types (MALT lymphoma, follicular lymphoma, duodenal-type follicular lymphoma, and small lymphocytic lymphoma) (p < 0.05). Conclusions: This study showed that most subtypes of gastrointestinal non-Hodgkin lymphomas exhibited same endoscopic features (superficial type and ulcer type). Aggressive gastrointestinal non-Hodgkin lymphomas (diffuse large B-cell lymphoma, mantle cell lymphoma, and T-cell lymphoma) were highly suspected when fungating lesions and protruding with ulcer lesions were encountered under endoscopy. Endoscopists should be aware of the connection between enhanced endoscopic characteristics and histological varieties of gastrointestinal lymphoma to improve diagnosis.

The prognostic impact of lymphoma perforation in patients with primary gastrointestinal lymphoma – a single-center analysis

ABSTRACT Patients with primary gastrointestinal (GI) lymphoma are at risk of GI perforations. Therefore, we aimed to investigate the prognostic impact of non-traumatic GI perforations. 54 patients with a histologically confirmed diagnosis of primary GI lymphoma were included. Non-traumatic lymphoma perforation occurred in ten patients (19%). Perforations occurred only in patients with aggressive B-cell lymphoma. In patients with aggressive B-cell lymphoma, the median overall survival (mOS) was 52 months (95% CI 9.88–94.12) and 27 months (95% CI 0.00–135.48) in patients with and without GI perforation, respectively. The median progression-free survival (mPFS) was 30 months (95% CI 5.6–54.4) in patients with GI perforations. In patients without lymphoma perforation, mPFS was not reached. Both mOS and mPFS did not significantly differ. In conclusion, despite the need for emergency surgery and delay in lymphoma-directed treatment, lymphoma perforation did not negatively impact our study population’s OS or PFS.

Deep learning model for predicting the survival of patients with primary gastrointestinal lymphoma based onthe SEER database and a multicentre external validation cohort.

Due to the rarity of primary gastrointestinal lymphoma (PGIL), the prognostic factors and optimal management of PGIL have not been clearly defined. We aimed to establish prognostic models using a deep learning algorithm for survival prediction. We collected 11,168 PGIL patients from the Surveillance, Epidemiology, and End Results (SEER) database to form the training and test cohorts. At the same time, we collected 82 PGIL patients from three medical centres to form the external validation cohort. We constructed a Cox proportional hazards (CoxPH) model, random survival forest (RSF) model, and neural multitask logistic regression (DeepSurv) model to predict PGIL patients' overall survival (OS). The 1-, 3-, 5-, and 10-year OS rates of PGIL patients in the SEER database were 77.1%, 69.4%, 63.7%, and 50.3%, respectively. The RSF model based on all variables showed that the top three most important variables for predicting OS were age, histological type, and chemotherapy. The independent risk factors for PGIL patient prognosis included sex, age, race, primary site, Ann Arbor stage, histological type, symptom, radiotherapy, and chemotherapy, according to the Lasso regression analysis. Using these factors, we built the CoxPH and DeepSurv models. The DeepSurv model's C-index values were 0.760 in the training cohort, 0.742 in the test cohort, and 0.707 in the external validation cohort, which demonstrated that the DeepSurv model performed better compared to the RSF model (0.728) and the CoxPH model (0.724). The DeepSurv model accurately predicted 1-, 3-, 5- and 10-year OS. Both calibration curves and decision curve analysis curves demonstrated the superior performance of the DeepSurv model. We developed the DeepSurv model as an online web calculator for survival prediction, which can be accessed at http://124.222.228.112:8501/ . This DeepSurv model with external validation is superior to previous studies in predicting short-term and long-term survival and can help us make better-individualized decisions for PGIL patients.

Retracted: Analysis of 78 Cases of Primary Gastrointestinal Lymphoma.

[This retracts the article DOI: 10.1155/2022/3414302.].

Outcomes in primary gastrointestinal (GI) follicular lymphoma (FL): results from a multicenter analysis

Introduction: GI FL is a rare disease, accounting for less than 5% of GI non-Hodgkin’s lymphomas (NHL). We formed a consortium to clarify baseline features, common practices and survival outcomes in primary GI FL. Methods: A retrospective analysis of 182 patients (pts) with primary GI FL from 8 institutions was conducted. Overall survival (OS) and progression-free survival (PFS) were assessed. Cox regression models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI). Results: Median age at diagnosis (dx) was 60 years (yrs) (IQR: 51–68). 89% (n = 141) of pts had low-grade FL by histology, and most presented with a low-risk score by FLIPI (68%, n = 111) or FLIPI-2 (76%, n = 103). At presentation, 18% (n = 32) of pts were asymptomatic, and 71% (n = 124) had at least one GI symptom, most commonly abdominal pain (40%, n = 70). 5% (n = 9) of pts presented with overt GI bleeding, and 9% (n = 15) with bowel obstruction. The most common first-line strategy was observation (33%, n = 59), of which 36% (n = 21) underwent surgical resection at dx. Other regimens included single-agent rituximab (R) (22%, n = 39), chemoimmunotherapy (CI) with R-bendamustine (18%, n = 32) or R-CHOP (11%, n = 19), and radiation therapy (5%, n = 9). The remainder received other CI combinations or R-lenalidomide. For those observed, median time to first treatment (tx) was 4.6 yrs. For those treated, overall response rate was 83% (95% CI, 76%–89%), and median time to second-line tx was 3.7 yrs. With median follow-up of 5.7 yrs, median OS was not reached. 5-yr PFS and OS were 71% (95% CI, 64%–79%) and 93% (95% CI, 89%–98%), respectively. Relevant factors that did not show a significant effect on PFS/OS included advanced disease by Paris and Ann Arbor staging systems, high-risk disease by FLIPI or FLIPI-2, B symptoms, GI symptoms, location of disease within the GI tract, and bone marrow involvement. Patients who were initially observed had similar OS to those who were treated up-front; PFS/OS did not improve significantly with use of maintenance rituximab. Factors that significantly impacted PFS and/or OS are outlined in Table 1. Conclusion: This multi-institutional analysis describes characteristics of the largest cohort of pts with GI FL to date. Observation or tx with rituximab ± chemotherapy were common initial approaches. Patients in this cohort had a good overall prognosis. While some factors including age, grade and BCL-2 expression by immunohistochemistry (IHC) predicted survival, traditional prognostic indices and staging systems did not. The research was funded by: No funding to disclose. Keyword: Extranodal non-Hodgkin lymphoma Conflicts of interests pertinent to the abstract. T. Alrifai Consultant or advisory role: Previous independent consultancy for MJH Life Sciences; completed in June of 2022. J. Kline Employment or leadership position: Speaker for Kite Pharma, Inc./Gilead. B.A.D Consultant or advisory role: Advisory boards for Merck, Kite Pharma, Inc./Gilead, Seattle Genetics, and Verastem Oncology Honoraria: Has received advisory board fees from Janssen, Sanofi, and consulting fees from COTA Healthcare. Research funding: Research support from Merck, iTeos, and Verastem Oncology R. Karmali Employment or leadership position: Speakers Bureau: AstraZeneca, BeiGene, Morphosys Consultant or advisory role: Advisory Board: BMS, Gilead Sciences/Kite Pharma, Janssen, Pharmacyclics, Morphosys, Epizyme, Genentech/Roche, Calithera, Miltenyi, Lilly Oncology Research funding: Grants/Research Support: BMS, Takeda, BeiGene, Gilead Sciences/Kite, Calithera

Incidental finding of multiple diffuse large B-cell lymphomas masquerading as jejunojejunal intussusception with unexplained pleural effusion: a case report.

This novel case report describes an 84-year-old man with multiple primary diffuse large B-cell lymphomas (DLBCLs) of the jejunum with disseminating pleural and multiple regional lymph nodes involvement presenting as intestinal obstruction and segments of jejunojejunal intussusception. The patient underwent surgical intervention and adjuvant chemotherapy. Unfortunately, the patient suffered from multiple organ failure and died 4 months after surgery. Obstruction and perforation are rare and life-threatening complications of GI lymphoma. Multiple DLBCLs of the jejunum are rare. Moreover, primary GI-DLBCL that initially presents with pleural effusion or with intestinal perforation is uncommon. This report aims to remind clinicians that lymphoma should be considered when assessing the cause of unexplained pleural effusion, especially when the available examination data cannot be confirmed by clinical manifestations. Through this case report, the authors learn that clinical manifestations, morphological characteristics, immunophenotypes, and molecular biological characteristics are vastly different and important. This poses the biggest challenge before surgery and should not be ignored.

Primary Duodenal Mucosa-associated Lymphoid Tissue Lymphoma Treated with Radiation Therapy Alone

Primary mucosa-associated with a lymphoid tissue (MALT) lymphoma is a rare distinct subtype of non-Hodgkin's lymphoma that occurs in approximately 8% of all non-Hodgkin lymphomas. Primary gastrointestinal MALT lymphoma usually occurs in the stomach, but duodenal involvement is extremely rare. Therefore, the clinical manifestations, treatment, and prognosis of primary duodenal MALT lymphoma have not yet been validated because of its rarity. This paper reports a case of a 40-year-old male with primary duodenal MALT lymphoma who was treated successfully with radiation therapy alone. A 40-year-old male visited for a medical check-up. Esophagogastroduodenoscopy revealed whitish multi-nodular mucosal lesions in the second and third portions of the duodenum. Biopsy specimens from mucosal lesions in the duodenum were reported to be suspicious for MALT lymphoma of the duodenum. He received a total dose of 3,000 cGy in 15 fractions with external beam radiation therapy for three weeks. Three months after radiation therapy, an endoscopic examination revealed complete resolution of the duodenal lesions. The follow-up 12 months after radiation therapy showed no evidence of tumor recurrence.

Prognosis and complications of patients with primary gastrointestinal diffuse large B-cell lymphoma: Development and validation of the systemic inflammation response index-covered score.

This study aimed to evaluate the predictive value of systemic inflammation response index (SIRI) in primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL) patients and establish a highly discriminating risk prediction model. This retrospective analysis included 153 PGI-DCBCL patients diagnosed between 2011 and 2021. These patients were divided into a training set (n=102) and a validation set (n=51). Univariate and multivariate Cox regression analyses were conducted to examine the significance of variables on overall survival (OS) and progression-free survival (PFS). An inflammation-covered score system was established according to the multivariate results. The presence of high pretreatment SIRI (≥1.34, p < 0.001) was significantly associated with poorer survival and identified as an independent prognostic factor. Compared with NCCN-IPI, the prognostic and discriminatory capability of the novel model SIRI-PI showed a more precise high-risk assessment with ahigher area under the curve (AUC) (0.916 vs 0.835) and C-index (0.912 vs 0.836) for OS in the training cohort, and similar results were obtained in the validation cohort. Moreover, SIRI-PI also showed good discriminative power for efficacy assessment. This new model identified patients at risk of developing severe gastrointestinal complications following chemotherapy. The results of this analysis suggested that the pretreatment SIRI may be a potential candidate for identifying patients with apoor prognosis. And we established and validated a better-performing clinical model, which facilitated the prognostic stratification of PGI-DLBCL patients and can serve as a reference for clinical decision-making.

Effect of Clinical, Endoscopic, Radiological Findings, and Complications on Survival in Patients with Primary Gastrointestinal Lymphoma.

The purpose of this study was to evaluate the clinical, endoscopic, and radiological characteristics, complications, survival outcomes, and prognostic factors of patients with primary gastrointestinal lymphoma. This study retrospectively analyzed the demographic, laboratory, endoscopic, and radiological characteristics and treatment outcomes of 43 patients with newly diagnosed primary gastrointestinal lymphoma. The median age was 62 years (range: 26-83). The primary lesion location was the gastric in 33 (77%) patients and the intestinal in 10 (23%) patients. The most common lesions were the corpus (33%) and corpus+antrum (24%) in primary gastric lymphoma and the ileum (60%) in primary intestinal lymphoma. The most common endoscopic findings were diffuse infiltrative lesion (23%) and massforming (33%), while the most common computed tomography finding was wall thickening (53%). Wall thickening and mass-forming at computed tomography were greater in primary intestinal lymphoma than in primary gastric lymphoma (P = .034). Complications were observed in 9 (21%) patients and 13 (31%) patients who underwent surgery. Complication and surgery rates were higher in primary intestinal lymphoma than in primary gastric lymphoma (P = .003 and P = .014, respectively). Five-year overall survival and 5-year eventfree survival rates were 75% and 72%, respectively. Univariate analysis showed that intestinal involvement, advanced clinical stage, a high International Prognostic Index score, mass-forming and wall thickening at computed tomography, extranodal involvement, and complication were found to adversely affect survival. Multivariate analysis revealed that intestinal involvement and a high International Prognostic Index score were independent prognostic factors for overall survival and event-free survival. Patients with primary gastrointestinal lymphoma with intestinal involvement and high International Prognostic Index score should be followed closely.