Diffuse Large B Cell Lymphomas Derived from the Gastrointestinal Tract Have Superior Survival Outcomes Compared to Those from a Non-Gastrointestinal Origin: Experience from a Single Institution

腸胃道瀰漫性大B型淋巴瘤存活率優於非腸胃道起源者：單一醫學中心之經驗

陳苓萍(Ling-Ping Chen) ； 林世哲(Shyh-Jer Lin)

《輔仁醫學期刊》 10卷1期 (2012/03) Pp. 1-12

摘要

Background and purpose: Diffuse large B cell lymphomas (DLBCLs) are the most common histological subtype of lymphomas, and gastrointestinal (GI) lymphomas are the leading cause of extranodal lymphomas. In this retrospective study, we tried to identify differences in clinical manifestations and treatment outcomes between DLBCLs with and without a GI origin. Methods: Among 602 newly diagnosed lymphoma patients between January 2000 and December 2009, 37 patients with GI DLBCLs and 196 patients with non-GI DLBCLs were enrolled. Primary central nervous system lymphomas and patients who did not receive immunochemotherapy were excluded. Results: Except for significantly higher counts of white blood cells and platelets (p=0.005 and 0.013) and lower levels of hemoglobin and serum calcium in the GI group (p=0.020 and 0.034), other patient characteristics were similar in these groups. While surgery was more frequently used in the GI group (p＜0.001), the other treatment modalities (all p＞0.05) and clinical responses (p=0.593) were comparable in the two groups. Nevertheless, the GI group demonstrated superior overall survival (OS) and progression-free survival (PFS) than its non-GI counterpart (p=0.0226 and 0.0436). Furthermore, a GI origin was proven to be an independent prognostic indicator of both OS (hazard ratio (HR) 0.358; 95% confidence interval (CI), 0.164~0.780; p=0.010) and PFS (HR 0.429; 95% CI, 0.210~0.878; p=0.021) according to the multivariate analysis. Conclusions: Extranodal involvement of the GI tract in DLBCLs demonstrated survival dominance and predictive values in the immunochemotherapy era. Because of limited numbers of patients included in the retrospective study, further large-scale studies are warranted to verify these results.

關鍵字

瀰漫性大B型淋巴瘤 ； 腸胃道淋巴瘤 ； 免疫化學治療

並列摘要

Background and purpose: Diffuse large B cell lymphomas (DLBCLs) are the most common histological subtype of lymphomas, and gastrointestinal (GI) lymphomas are the leading cause of extranodal lymphomas. In this retrospective study, we tried to identify differences in clinical manifestations and treatment outcomes between DLBCLs with and without a GI origin. Methods: Among 602 newly diagnosed lymphoma patients between January 2000 and December 2009, 37 patients with GI DLBCLs and 196 patients with non-GI DLBCLs were enrolled. Primary central nervous system lymphomas and patients who did not receive immunochemotherapy were excluded. Results: Except for significantly higher counts of white blood cells and platelets (p=0.005 and 0.013) and lower levels of hemoglobin and serum calcium in the GI group (p=0.020 and 0.034), other patient characteristics were similar in these groups. While surgery was more frequently used in the GI group (p＜0.001), the other treatment modalities (all p＞0.05) and clinical responses (p=0.593) were comparable in the two groups. Nevertheless, the GI group demonstrated superior overall survival (OS) and progression-free survival (PFS) than its non-GI counterpart (p=0.0226 and 0.0436). Furthermore, a GI origin was proven to be an independent prognostic indicator of both OS (hazard ratio (HR) 0.358; 95% confidence interval (CI), 0.164~0.780; p=0.010) and PFS (HR 0.429; 95% CI, 0.210~0.878; p=0.021) according to the multivariate analysis. Conclusions: Extranodal involvement of the GI tract in DLBCLs demonstrated survival dominance and predictive values in the immunochemotherapy era. Because of limited numbers of patients included in the retrospective study, further large-scale studies are warranted to verify these results.

並列關鍵字

diffuse large B cell lymphoma ； gastrointestinal lymphoma ； immunochemotherapy