Clinicopathological Features, Treatment Strategy, and Prognosis of Primary Non-Hodgkin’s Lymphoma of the Duodenum: A SEER Database Analysis

Abstract

Objective. Primary duodenum lymphoma (PDL) is extremely rare with limited data available in the literature. In this study, we sought to describe clinical features and identify factors affecting survival in patients with PDL using a large population cohort. Methods. The Surveillance, Epidemiology, and End Results (SEER) database was queried from 1998 to 2015. Results. A total of 1060 cases of PDLs were identified. Clinicopathological features as well as survival data of PDLs were analyzed and compared with 10573 primary gastric lymphomas (PGLs) and 3239 primary small intestinal lymphomas (PSILs) from the SEER database. PDL patients were younger in age (60.96 ± 15.205), and the proportion of stage I (53.21%) was higher in Ann Arbor staging. The proportion of PDLs treated by surgery (8.68%) is the lowest among PDLs, PGLs, and PSILs. The DSS of PDLs were significantly better than those of PGLs and PSILs, respectively (10-year survival rate: 21.24% vs. 20.40%, P=0.027; 10-year survival rate: 21.24% vs. 16.79%, P=0.001). Age, gender, Ann Arbor staging, and histological type were regarded as independent prognostic factor for the DSS by multivariate analysis (all P<0.05). Patients with <65 years, female, stage I, and FL were found to be significantly associated with good DSS. The treatment modality (surgery vs. conservative treatment) was not statistically related to DSS. The proportion of PDL patients who received surgical treatment gradually decreased from 15.60% in period 2 to 5.26% in period 4. Conclusions. The clinicopathologic features of duodenal lymphoma were significantly different from those of gastric lymphoma and small intestinal lymphoma. The prognosis of PDLs was significantly better than those of the other two groups, and there was no statistical survival benefit from surgery in PDLs.

Epidemiology and Determinants of Survival for Primary Intestinal Non-Hodgkin’s Lymphoma – A Population Based Study

“…DLBCL and BL had similar incidence in small and large intestine, whereas MALTOMA and Mantle cell lymphoma was more common in the large intestine (Table 2). Similar findings were seen in previous studies comprising data from multiple centers (12,14,15). While the median OS of primary intestinal T-cell lymphoma was 6 months, and PI-DLBCL 71 months, it was not reached in follicular lymphoma and was 165 months in MALToma.…”

“…This is the only study which has reported population-based age-adjusted incidence rate with incidence rate ratio close to twice for male compared to female, 0.62 times for non-Hispanic black and 0.92 times for Hispanic patients compared to non-Hispanic white population. In the previous studies, the number of reported cases were almost twice in the males for the eastern Asian population to 1.5 times in German and North American populations, which were seen in our patient group as well (9,11,12).…”

“…This could indicate that many PI-NHL presents with intestinal mass and symptoms of obstruction, which necessitates the use of surgical intervention for immediate management. In a report published from China, around 48% of patients with PI-NHL required surgical intervention(12). In a recent report published from the SEER database on duodenal NHL, there has been a decline in the proportion of patients requiring surgery for duodenal NHL.…”

Outcomes of Lymphoma Among American Adolescent and Young Adult Patients Varied by Health Insurance—A SEER-based Study

“…Survival information was measured in months rather than exact days. For this reason and given the exclusion of patients with only autopsy or death certificates, the surviving time of 0 months was regarded as 0.5 month to enroll any patient who died within 1 month of diagnosis 24,25…”

“…For this reason and given the exclusion of patients with only autopsy or death certificates, the surviving time of 0 months was regarded as 0.5 month to enroll any patient who died within 1 month of diagnosis. 24,25 As SEER is available to the public and this study does not identify patient data, no ethical approval from the Institutional Review Board was needed.…”