The Clinical Characteristics,Treatment And Prognosis For Primary Colorectal Lymphoma

Background:Primary colorectal lymphoma(PCL)is a rare colorectal malignancy in clinic.The standard treatment and prognostic factors of PCL remain uncertain.This study aims to investigate the clinical characteristics and prognostic factors based on a large population database and data from our medical center,moreover,to provide evidences for the treatment guidelines of PCL in a degree.Material and Methods:We extracted eligible patients with PCL registered in the SEER database from 1973 to 2011 and dignosed in The Second Affiliated Hospital,Zhejiang University School of Medicine from 2000 to 2017.The Kaplan-Meier method was performed to calculate the median survival,and log-rank statistics were used to detect survival differences between the various covariates.We performed the Cox proportional hazard model to detect the potential prognostic factors.Results:Of 3342 patients with PCL identified,2050(61.3%)underwent surgical intervention and 1292(38.7%)without surgical treatment.The median overall survival was 95 months,and surgical intervention could significantly prolong long-term survival in patients with PCL(adjusted HR:0.69,P<0.001).Patients with younger age,earlier tumor stage,and indolent lymphoma may have a better prognosis.Further survival analysis demonstrated the survival benefit from surgery in patients with early tumor stage(adjusted HR=0.57,P<0.001),right-sided lesion(adjusted HR=0.68,P<0.001)and diffuse large B-cell(adjusted HR=0.65,P<0.001)PCL.Of 35 patients dignosed as PCL in our medical center from 2000 to 2017,27(77.1%)were B-cell lineage lymphoma and 8(22.9%)were T-cell lineage lymphoma.The 5-year overall survival rate of these patients is 61.1%.T-cell lineage lymphoma type PCL patients dignosed at youger age and reduced overall survival(P=0.006).Chemotherapy might improve long-term survival of PCL patients.Five-year overall survival rates were 64.3%for chemotherapy group and 50.0%for non-chemotherapy ones respectively(P=0.015).Conclusion:Surgical intervention and chemotherapy might play important roles in comprehensive treatment of PCL.Early tumor stage,right-sided lesion,and diffused large B-cell histologic type seemed to be the clinical characteristics of optimal surgical candidates.Incidence rate of T-cell lineage lymphoma originated from colorectum is higher in the Eastern population.This pathological type PCL would be diagnosed at a younger age and associated with a poor prognosis.