Localized primary gastrointestinal diffuse large B cell lymphoma received a surgical approach: an analysis of prognostic factors and comparison of staging systems in 101 patients from a single institution

Abstract

BackgroundDiffuse large B cell lymphoma (DLBCL) represents the most common histological subtype of primary gastrointestinal lymphoma and is a heterogeneous group of disease. Prognostic characterization of individual patients is an essential prerequisite for a proper risk-based therapeutic choice.MethodsClinical and pathological prognostic factors were identified, and predictive value of four previously described prognostic systems were assessed in 101 primary gastrointestinal DLBCL (PG-DLBCL) patients with localized disease, including Ann Arbor staging with Musshoff modification, International Prognostic Index (IPI), Lugano classification, and Paris staging system.ResultsUnivariate factors correlated with inferior survival time were clinical parameters [age >60 years old, multiple extranodal/gastrointestinal involvement, elevated serum lactate dehydrogenase and β2-microglobulin, and decreased serum albumin], as well as pathological parameters (invasion depth beyond serosa, involvement of regional lymph node or adjacent tissue, Ki-67 index, and Bcl-2 expression). Major independent variables of adverse outcome indicated by multivariate analysis were multiple gastrointestinal involvement. In patients unfit for Rituximab but received surgery, radical surgery significantly prolonged the survival time, comparing with alleviative surgery. Addition of Rituximab could overcome the negative prognostic effect of alleviative surgery. Among the four prognostic systems, IPI and Lugano classification clearly separated patients into different risk groups. IPI was able to further stratify the early-stage patients of Lugano classification into groups with distinct prognosis.ConclusionsRadical surgery might be proposed for the patients unfit for Rituximab treatment, and a combination of clinical and pathological staging systems was more helpful to predict the disease outcome of PG-DLBCL patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-015-0668-5) contains supplementary material, which is available to authorized users.

Prognostic nomogram for overall survival in upper aerodigestive tract extranodal natural killer/T‑cell lymphoma, nasal type, stages IE and IIE: A SEER‑based study

“…Notably, studies from Wang et al (42) and Dai et al (43) reported that in early-stage ENKTCL, B symptoms, including fever, weight loss and night sweats, are not associated with prognosis. The results from the present study were consistent with those from these previous studies (41,42), and were also similar to those from studies on some early-stage lymphomas (44,45).…”

The Lymphocyte–Monocyte Ratio and the Platelet–Lymphocyte Ratio at Diagnosis as Independent Prognostic Factors in Primary Gastrointestinal Diffuse Large B Cell Lymphoma

“…Endoscopic examination combined with pathological biopsy is still the most important and reliable method for detection of PGI-DLBCL. Nowadays, there is still no consensus on its treatment, the majority of patients were treated with combined therapy (chemotherapy and radiotherapy, surgery plus chemotherapy, surgery plus chemotherapy, and radiotherapy).The majority of chemotherapeutic protocols was CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone)-like regimens and/without rituximab [4][5][6]. Immunodeficiency is considered to be one of the most dangerous factors in NHL, with a greater risk of developing lymphoma with congenital or acquired immunodeficiency.…”

Renaissance of Radiotherapy in Intestinal Lymphoma? 10-Year Efficacy and Tolerance in Multimodal Treatment of 134 Patients: Follow-up of Two German Multicenter Consecutive Prospective Phase II Trials

“…We identified the histologic subtype of iL as a relevant but nonsignificant factor associated with lymphoma-specific survival, observing more patients with aggressive histologic subtype who died of disease [17,18].…”