Variable Clinical Features And Outcomes Of Nodal, Extranodal And Waldeyer's Ring Diffuse Large B-cell Lymphoma

Objective This study is to analyze the clinical characteristics of nodal,extranodal and Waldeyer's ring diffuse large B-cell lymphoma(DLBCL).Methods Two hundred and eighty patients consecutively diagnosed with nodal DLBCL (N-DLBCL),extranodal DLBCL(E-DLBCL) and Waldeyer's ring DLBCL (WR-DLBCL) were reviewed.101 patients had a primary N-DLBCL,80 patients had a primary WR-DLBCL,and 99 had a primary E-DLBCL.218 patients with stageâ… -â…¡were treated with chemotherapy and radiotherapy,whereas 62 patients with stageâ…¢-â…£received primary chemotherapy.Results Patients with WR-DLBCL presented with more stageâ…¡diseases,frequent involvement of adjacent organs or tissues,less B symptoms,less involvement of spleen, less elevated lactate dehydrogenase(LDH) andβ₂-microglobulin(β₂M) level compared with N-DLBCL or E-DLBCL.Patients with E-DLBCL presented with poorer ECOG score.The 5-year overall survival(OS) rate for all patients was 76%for WR-DLBCL, 56%for N-DLBCL and 79%for E-DLBCL(P=0.190),respectively.The corresponding OS rate for stageâ… andâ…¡diseases was 78%for WR-DLBCL,58%for N-DLBCL,and 83%for E-DLBCL(P=0.146),respectively.On univariate analysis,elevated LDH, international prognostic index(IPI),and elevatedβ₂M were prognostic predictors for WR-DLBCL patients,elevatedβ₂M,bulky disease for N-DLBCL patients,and poor ECOG score,IPI for E-DLBCL.Conclusions Compared with patients with N-DLBCL,patients with WR-DLBCL appears to have distinct clinical features and favorable prognosis.E-DLBCL represents a heterogeneous group of lymphomas,with good prognosis in gastrointestinal or other presentations and poor prognosis in central nerve system and testis presentations.