Diagnostic and prognostic factors for patients with primary pulmonary non‑Hodgkin's lymphoma: A 16‑year single‑center retrospective study

Abstract

Primary pulmonary non-Hodgkin's lymphoma (PP-NHL) is a rare entity with non-specific symptoms and radiographic findings, as well as a difficult preoperative diagnosis. A limited number of studies have described PP-NHL in Chinese patients. The goal of the present study was to improve early diagnosis by examining prognostic factors in patients with PP-NHL. Therefore, a total of 29 patients with PP-NHL were included in the study between January 2001 and June 2017, including 14 with aggressive-type and 15 with indolent-type lymphomas (10 male, 19 female; median age, 50.3 years; range, 19-87 years). Pulmonary nodules and masses (55.2%) were the most common radiographic features. The diagnostic yield was 80% (12/15) by endobronchial biopsy or transbronchial lung biopsy and 100% by computed tomography (CT)-guided percutaneous needle lung biopsy (11/11) or surgery (8/8). Elevated lactate dehydrogenase levels and systemic symptoms were observed considerably more often in patients with aggressive disease than in those with indolent disease. The 1-, 3-and 5-year overall survival (OS) rates were 42, 32, and 21%, respectively, for all patients, 72, 57 and 43%, respectively, for patients with indolent lymphomas, and 13, 6 and 0%, respectively, for patients with aggressive lymphomas. The median OS rate for all patients was 12.0 months; however, the OS rate for patients with aggressive lymphomas was significantly shorter compared with those with indolent lymphomas (7.1 months vs. 16.6 months; P=0.002). Aggressive vs. indolent lymphoma status was indicated to be an independent prognostic factor for poor 5-year OS rate (hazard ratio, 5.98; P=0.014). In conclusion, bronchoscopic and CT-guided percutaneous needle lung biopsies were the most useful and least invasive procedures for diagnosing PP-NHL. Furthermore, aggressive PP-NHL was highly associated with poor 5-year OS rate and a poor prognosis.

Treatment and prognosis of primary pulmonary lymphoma: A long‐term follow‐up study

“…From literature, aggressive PPL tended to have earlier stages (IE‐IIE) in 96%, 100%, 98%, and 100% of cases, respectively 3,11,16,17 . The LDH level was confirmed to be normal in 79% and 55.2% of patients, 17,18 and no bone marrow involvement was present 3,16,17 .…”

“…No specific prognostic factors influencing survival have been clearly defined in several papers for PPL patients 3,6,16‐18 …”

Primary pulmonary lymphoma presenting as nodules and masses: a case report and literature review

“…The radiographic appearance of PPL showed a variety of findings, such as single or multiple nodules, masses, ill-defined infiltrates and consolidations [8]. This suggests that any radiological abnormality of the lung parenchyma contains the possibility of lymphoma.…”

Rapidly progressing primary pulmonary lymphoma masquerading as lung infectious disease: A case report and review of the literature

“…In recent years, 18 F-2-deoxy-2-fluoro-D-glucose-positron emission tomography/CT has developed rapidly in the field of staging of lymphoma and efficacy evaluation of treatment due to its more sensitive display than conventional CT. Lee et al [ 31 ] showed higher standardized uptake values (SUVs) in systemic ALCL than in other types of aggressive T-cell lymphoma, as well as higher SUVs in ALK-positive ALCL patients than in ALK-negative ones. It is necessary for definite diagnosis by CT-guided percutaneous needle lung biopsies as soon as possible[ 32 ].…”