Clinical Features And Prognostic Analysis Of Patients With Primary Intestinal B-Cell Lymphoma

Objective: To investigate the clinical characteristics and prognostic factors of patients with primary intestinal B cell lymphoma.Methods: We gathered 50 cases of patients who were diagnosed with primary intestinal B cell non-Hodgkin’s lymphoma and were treated in the Affiliated Union Hospital of Fujian Medical University from January 1st, 2004 to December 31 st,2013. We collected follow up data, covered every patient’s age, gender, clinical symptoms, laboratory tests, pathological type, immunohistochemical markers,lesions sites, international prognostic index(IPI), ECOG score, treatment strategies and overall survival time. And the risk factors for overall survival rate were anlaysied by univariate and multivariate analysis.Results: The study included 35 male patients and 15 female ones.The sex ratio was 2.33 : 1. The median age was 58 years(ranging from 16-79 years). Clinical symptoms include: 34 cases(70%) of abdominal pain or abdominal distension, 21 cases(42%) of anemia, 8 cases(16%) of bowel evacuation habit chaning, 1 case(2%) of fever, 5 cases(10%) of abdominal mass. Among those cases, 21 of which(42%) were accompanied by complications, such as intestinal bleeding, intestinal obstruction, intussusception and intestinal perforation, and 19 of which(38%) went with B symptoms. The most common origins were small intestine and ileocecus, which accounted for 36%(18 cases) respectively. Besides, colon accounted for 12%(6 cases), anorectum for 8%(4 cases), and multiple PIL involvements for 8%(4 cases). Complete follow-up data were obtained in 43 cases, but 19 patients(44.2%) died. The median survival time was 49.4 months. The 1-year OS, 3-year OS and 5-year OS rate were 79.1%, 71.9% and 58.2%, respectively. Univariate analysis indicated that patients who were at Lugano stage III and IV, high LDH levels, low hemoglobin levels, albumin<30g/l, the diamete of mass ≥10cm, IPI≥2, ECOG≥2, had poor prognosis. While gender, age, B symptoms, lesion position, complications, pathological types, treatment strategies and immunohistochemistry markers(CD10, CD5, bcl-2 and bcl-6) had little effect on the prognosis. The efficacy analysis showed that R-CHOP like treatment group was better than that of CHOP like treatment group on overall survival(P=0.048). Multivariate analysis showed that IPI score >2(OR=6.766, 95%CI 1.853~24.702, P=0.004) was an independent risk factors for the prognosis of intestinal B cell lymphoma.Conclusion: Primary intestinal B cell lymphoma is a heterogeneous disease and primarily affects middle-aged men.The lesions always occured in the small intestine and ileocecus.Diffuse large B cell lymphoma(DLBCL) is the most common pathological type.It was lack of clinical feature and often accompanied by complications,such as obstruction,perforation and so on. IPI can be used as an important indicator for clinical treatment and prognosis evaluation of primary intestinal B cell lymphoma. And some patients with primary intestinal B cell lymphoma may survive by using rituximab.