Intestinal Diffuse Large B-Cell Lymphoma: An Evaluation of Different Staging Systems

Abstract

The gastrointestinal tract is the most common primary extranodal site for diffuse large B-cell lymphoma (DLBCL). However, there is no consensus on the most appropriate staging system for intestinal DLBCL. We evaluated the utility of the modified Ann Arbor system, the Lugano system, and the Paris staging system (a modification of the Tumor, Node, Metastases [TNM] staging for epithelial tumors) in 66 cases of resected intestinal DLBCL. The cases were treated with surgery, plus either cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy alone (n=26) or with the addition of rituximab immunotherapy (n=40). Median follow-up time was 40.4 months (range, 2.1-171.6 months). Fifty-six patients (84.8%) achieved complete remission. The overall 5-yr survival rate was 86.4% (57/66). Of the stage categories defined for each staging system, only the T stage of the Paris classification showed prognostic significance for overall survival by univariate analysis. However, none of the stage parameters was significantly correlated with patient survival on multivariate analysis. In conclusion, the results suggest that the T stage of the Paris classification system may be a prognostic indicator in intestinal DLBCL. The results also imply that in surgically resected intestinal DLBCL, the addition of rituximab to the CHOP regimen does not confer significant survival advantage.

Primary small intestinal non-Hodgkin lymphomas that have been diagnosed after emergency surgery

“…Incidence of PGI NHL was higher in women than in men (male:female ratio: 8:9), which was not consistent with previous studies. [5,6] This is likely due to small number of patients included in present study.…”

A new extranodal scoring system based on the prognostically relevant extranodal sites in diffuse large B-cell lymphoma, not otherwise specified treated with chemoimmunotherapy

“…These discordances can be attributed to the differences between the various treatment protocols. For example, more than half (60.7 %) of the patients with intestinal involvement in our current cohort underwent a resection of an intestinal lymphoma prior to chemotherapy, a treatment known to be effective in improving the patient outcome [25,26]. In addition, the relatively younger age of our cohort (median age, 55 years) may result in the alteration of survival analysis results and may cause these discordances.…”

Clinical trends and management outcome of primary intestinal lymphoma

“…Also, the majority of authors concluded that the initial management with surgery followed by adjuvant chemotherapy resulted in the best overall survival. 4,11,[25][26][27] Meanwhile, surgical resection is beneficial to prevent spontaneous perforation and/or hemorrhage during chemotherapy or radiotherapy, also to relieve symptoms and for accurate diagnosis and staging of the disease.…”